Hesi Rn 301 pharmacology Exam

Correct Answer:

Ototoxicity and nephrotoxicity

Explanation:

Gentamicin is an aminoglycoside antibiotic with well-known risks of ototoxicity (damage to the inner ear) and nephrotoxicity (kidney injury). Ototoxicity can present as tinnitus, hearing loss, or balance problems and may be irreversible. Nephrotoxicity is due to accumulation of the drug in renal tubular cells, leading to rising creatinine and decreased kidney function. The risks increase with prolonged therapy, high trough levels, preexisting renal impairment, or concurrent use of other nephrotoxic drugs. The nurse should monitor hearing changes, vestibular symptoms, urine output, and renal function tests (BUN, creatinine), and notify the provider promptly if signs of toxicity appear.

Why Other Options Are Incorrect:

Neurotoxicity and hepatotoxicity

Gentamicin is not commonly associated with neurotoxicity or liver injury; these are not primary concerns with this drug.

Cardiotoxicity and retinopathy

These are not known adverse effects of gentamicin; cardiotoxicity is more linked to certain chemotherapy agents, and retinopathy is associated with drugs like hydroxychloroquine.

Pulmonary toxicity and neuropathy

These are associated with drugs like amiodarone (pulmonary) and chemotherapy agents (neuropathy), not aminoglycosides.

Correct Answer:

None – folic acid alone is recommended

Explanation:

Folic acid alone is the recommended supplement to reduce the risk of neural tube defects such as spina bifida and anencephaly. Pregnant women are advised to take 400–800 mcg daily before conception and during early pregnancy. No additional drug should be combined for this purpose.

Why Other Options Are Incorrect:

Methotrexate

This is teratogenic and can cause severe birth defects, including neural tube defects, and should be avoided in pregnancy.

Warfarin

An anticoagulant that crosses the placenta and can cause fetal bleeding and malformations; it is unsafe in pregnancy.

Isotretinoin

A potent teratogen associated with severe birth defects, including craniofacial, cardiac, and central nervous system abnormalities; absolutely contraindicated in pregnancy.

Correct Answer B. For long-term control of normal eye pressure.

Explanation:

Open-angle glaucoma is a chronic condition caused by impaired drainage of aqueous humor, leading to increased intraocular pressure (IOP). Medications, such as prostaglandin analogs or beta-blockers, do not cure glaucoma but control IOP to prevent optic nerve damage. Treatment is lifelong to maintain normal eye pressure and preserve vision. Discontinuing therapy can lead to irreversible vision loss.

Why Other Options Are Wrong:

A. Until a smaller angle can be restored.

Open-angle glaucoma is not caused by a narrow angle; this describes a different condition (angle-closure glaucoma). There is no surgical or medication-based “angle restoration” in open-angle cases.

C. For long-term control of pain and swelling.

Glaucoma medications are not intended for pain or swelling control. Most open-angle glaucoma patients are asymptomatic until late stages, making pressure control—not pain relief—the treatment focus.

D. Until the excess pressure is reduced.

While medications reduce intraocular pressure, stopping them after an initial reduction will allow pressure to rise again. Long-term continuous therapy is required, not just short-term use until pressure drops.

Correct Answer:

Cyclosporine

Explanation:

Cyclosporine is metabolized by the CYP3A4 enzyme system in the liver and intestines. Grapefruit juice inhibits this enzyme, leading to increased blood levels of cyclosporine, which raises the risk for nephrotoxicity, neurotoxicity, and other adverse effects. Clients should avoid grapefruit and grapefruit juice during therapy.

Why Other Options Are Incorrect:

Amoxicillin

Amoxicillin absorption and metabolism are not significantly affected by grapefruit juice, so it can be taken without concern for this specific interaction.

Furosemide

Furosemide does not interact with grapefruit juice. The main concerns are electrolyte imbalances and dehydration, not CYP enzyme inhibition.

Metoprolol

Metoprolol has minimal interaction with grapefruit juice, and its metabolism is not significantly altered to a dangerous level.

Correct Answer A. I need to notify my healthcare provider if I lose my appetite or get nauseated.

Explanation:

Loss of appetite and nausea are early signs of digoxin toxicity, which can be life-threatening if untreated. Promptly notifying the healthcare provider ensures that digoxin levels can be evaluated and dosage adjustments made if necessary. Early intervention helps prevent severe toxicity and complications such as dangerous cardiac arrhythmias.

Why Other Options Are Wrong:

B. I should take my furosemide only if I have shortness of breath or swelling in my feet.

Furosemide should be taken as prescribed, not based solely on symptom presence. Skipping doses can lead to fluid retention and worsening heart failure.

C. I need to check my blood pressure three times a day.

While monitoring blood pressure is important, it is not the primary focus of patient education for digoxin and furosemide therapy. Daily weight monitoring and symptom reporting are typically more critical.

D. If I lose more than one pound in a week, I should hold my next dose of furosemide.

Mild weight loss in heart failure is often a sign of fluid removal and is expected with diuretic therapy. Holding a dose without provider guidance could lead to fluid overload and worsening symptoms.

Correct Answer:

Penicillins

Explanation:

Cephalosporins share a similar beta-lactam structure with penicillins, which means patients with a history of penicillin allergy may have a higher risk of cross-reactivity. While the risk is lower with newer-generation cephalosporins, it remains clinically significant. Before administration, the nurse should specifically ask about any past allergic reactions to penicillins, noting the type and severity of the reaction. Anaphylactic history would be a contraindication for giving a cephalosporin.

Why Other Options Are Incorrect:

Soy products

Soy allergies are not relevant to cephalosporin use, as these drugs are not derived from soy or soy-based ingredients.

Peanuts

Peanut allergies have no cross-reactivity with cephalosporins. Peanuts are not involved in cephalosporin formulation.

Opioids

Opioid allergies are unrelated to cephalosporin administration. Opioids are a separate class of drugs without shared allergenic components with antibiotics.

Correct Answer:

Apical heart rate 48/min

Explanation:

Metoprolol is a beta-1 adrenergic blocker that slows the heart rate and decreases myocardial contractility. Before administering, the nurse should assess the apical pulse for a full minute. If the heart rate is below 50–60 beats/min (per provider or facility protocol), the medication should be held and the provider notified due to the risk of symptomatic bradycardia, hypotension, and possible heart block. This is a priority safety measure.

Why Other Options Are Incorrect:

Blood pressure 152/88 mm Hg

This is elevated and may actually be an indication for metoprolol use; it is not a reason to hold the drug.

Blood glucose 130 mg/dL

This is slightly above normal fasting range but not critical. While beta-blockers can mask hypoglycemia symptoms, this reading does not warrant holding the medication.

Mild fatigue

Fatigue is a common side effect of beta-blockers but is not an immediate reason to withhold the dose unless it is severe or associated with other concerning signs.

Correct Answer:

Takes metformin hydrochloride for type 2 diabetes mellitus.

Explanation:

Metformin use before administration of IV contrast requires follow-up because the combination can increase the risk of lactic acidosis, particularly in clients with reduced kidney function. Contrast dye can impair renal function, which may reduce metformin clearance and lead to dangerous accumulation. The nurse must notify the healthcare provider so that metformin can be withheld prior to the scan and kidney function monitored after the procedure.

Why Other Options Are Wrong:

Metal hip prosthesis was placed twenty years ago.

A metal hip prosthesis does not interfere with a CT scan; the main imaging concern with metal is in MRI studies due to magnetic interference. This history does not require follow-up for a CT with contrast.

Report of client's sobriety for the last five years.

While substance use history is important for overall health, a history of sobriety has no direct implications for contrast administration in a CT scan and does not require follow-up in this context.

CT scan that was performed six months earlier.

A prior CT scan within the past few months is not a contraindication to a new scan unless there are concerns about cumulative radiation exposure, which is minimal in urgent diagnostic situations. This history alone does not require immediate follow-up.

Correct Answer:

Take each morning on an empty stomach, separate from other meds

Explanation:

Levothyroxine absorption is best when taken in the morning on an empty stomach, at least 30–60 minutes before breakfast. It should also be taken separately (by at least 4 hours) from calcium, iron, and certain other medications that can interfere with its absorption. Consistency in timing and administration is critical for stable thyroid hormone levels.

Why Other Options Are Incorrect:

Take with breakfast for best absorption

Food decreases levothyroxine absorption, so this would reduce its effectiveness.

Take at bedtime with calcium

Calcium significantly interferes with levothyroxine absorption; they should be separated by at least 4 hours.

Skip a dose if heart rate is above 60/min

A heart rate above 60/min is normal; the drug should not be skipped unless signs of overtreatment (tachycardia, palpitations) or toxicity occur and the provider is consulted.