NUA 285 Pharmacotherapeutics at Georgian Court University
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Free NUA 285 Pharmacotherapeutics at Georgian Court University Questions
A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order which of the following?
- A narrow-spectrum antibiotic
- Multiple antibiotics
- The pneumococcal vaccine
- A broad-spectrum antibiotic
Explanation
D. A broad-spectrum antibiotic
Explanation
When the causative organism is unknown—such as when a sputum sample cannot be obtained—treatment for pneumonia typically begins with a broad-spectrum antibiotic. These drugs are effective against a wide range of bacteria and help control the infection until culture results or clinical findings allow for more targeted therapy. Once the pathogen is identified, the provider may switch to a narrow-spectrum antibiotic to minimize resistance and adverse effects.
The nurse is caring for a patient receiving vancomycin. The nurse is aware the medication should be administered over 2 hours. What is a major adverse effect associated with rapid infusion of vancomycin?
- Gastrointestinal bleeding
- Red man syndrome
- Hypertension
- Nausea and vomiting
Explanation
B. Red man syndrome
Explanation
Red man syndrome is a major adverse reaction that occurs when vancomycin is infused too rapidly. It is caused by histamine release and is characterized by flushing, erythema, pruritus, and hypotension, especially involving the face, neck, and upper torso. To prevent this reaction, vancomycin should be administered slowly over at least 1–2 hours and diluted appropriately. If symptoms occur, the infusion should be stopped immediately, and the healthcare provider notified. Once symptoms resolve, the infusion can be restarted at a slower rate. Antihistamines may also be given to reduce the reaction.
The nurse administered 25 units of Regular (Humulin/Novolin) insulin to a patient with type 1 diabetes at 1600. Which intervention should the nurse implement?
- Ensure the patient eats their bedtime snack.
- Check the patient's serum blood glucose level.
- Assess the patient for hypoglycemia around 1730.
- Serve the patient the supper tray.
Explanation
D. Serve the patient the supper tray.
Explanation
Regular insulin (Humulin R or Novolin R) is a short-acting insulin with an onset of 30–60 minutes, peak effect in 2–4 hours, and duration of 6–8 hours. Because the nurse administered it at 1600 (4:00 PM), the patient’s blood glucose will begin to decrease as the insulin starts working. To prevent hypoglycemia, the patient must eat a meal shortly after administration—in this case, the supper tray should be served immediately. The nurse should also continue monitoring blood glucose during the expected peak time (around 1800–2000) for signs of hypoglycemia such as sweating, tremors, or confusion.
A young woman tells the nurse that she has a strong family history of osteoporosis and that she has been taking calcium supplements. Which vitamin will the nurse recommend as an adjunct to calcium supplementation?
- Vitamin K
- Vitamin D
- Vitamin A
- Vitamin E
Explanation
B. Vitamin D
Explanation
Vitamin D is essential for the absorption and utilization of calcium in the intestines and for maintaining proper bone mineralization. Without adequate vitamin D, calcium cannot be effectively absorbed, which increases the risk of osteopenia and osteoporosis despite supplementation. The nurse should educate the patient that vitamin D can be obtained from sunlight exposure, fortified foods, and supplements. This combination of calcium and vitamin D helps strengthen bones and reduce fracture risk. Vitamins A, E, and K play other roles in the body but do not significantly aid calcium absorption or bone health in this context.
A client is experiencing an anaphylactic allergic reaction after eating peanuts. The client is ordered to receive epinephrine (Adrenalin). This medication is considered a nonspecific adrenergic receptor drug because it innervates __________ receptor sites.
- Beta-adrenergic
- Alpha-adrenergic
- Dopamine
- Alpha and beta adrenergic
Explanation
D. Alpha and beta adrenergic
Explanation
Epinephrine is a nonselective adrenergic agonist, meaning it stimulates both alpha and beta receptors throughout the body. Activation of alpha receptors causes vasoconstriction, which increases blood pressure and reduces airway swelling. Stimulation of beta₁ receptors increases heart rate and cardiac output, while beta₂ receptor activation causes bronchodilation, improving airflow during anaphylaxis. This combined action makes epinephrine the drug of choice for treating severe allergic reactions and anaphylactic shock.
A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect?
- Orthostatic hypotension
- Blurred vision
- Urinary retention
- Muscle weakness
Explanation
D. Muscle weakness
Explanation
Muscle weakness may indicate myopathy or rhabdomyolysis, a serious adverse effect of simvastatin and other statins. This occurs due to muscle tissue breakdown, which releases myoglobin that can damage the kidneys. The nurse should report this finding immediately and expect laboratory testing for creatine kinase (CK) levels. Early detection and discontinuation of the drug can prevent permanent muscle or renal damage.
A patient is prescribed diltiazem for hypertension. What should the nurse monitor the patient for?
- Gout
- Chronic kidney disease
- Heart failure
- Hyperthyroidism
Explanation
C. Heart failure
Explanation
Diltiazem is a calcium channel blocker (CCB) that lowers blood pressure by reducing myocardial contractility and causing vasodilation. Because it decreases the force of cardiac contraction and slows conduction through the AV node, it can worsen or precipitate heart failure, especially in patients with preexisting ventricular dysfunction.
The nurse should monitor for signs of heart failure, including shortness of breath, peripheral edema, weight gain, and crackles in the lungs. Blood pressure and heart rate should also be regularly assessed to detect hypotension or bradycardia.
A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects?
- Constipation
- Tachycardia
- Drowsiness
- Oliguria
Explanation
B. Tachycardia
Explanation
Theophylline (Theo-24) is a methylxanthine bronchodilator that relaxes smooth muscles of the bronchi, improving airflow in asthma and COPD. However, because of its stimulant effects on the central nervous and cardiovascular systems, it can cause tachycardia, palpitations, restlessness, insomnia, and tremors—especially when serum levels exceed the therapeutic range (10–20 mcg/mL). The nurse should instruct the client to report chest pain, rapid heartbeat, or nervousness and to avoid caffeine, as it can increase theophylline toxicity. Regular blood level monitoring is essential to prevent adverse effects.
Nonselective beta blockers such as propranolol (Inderal) are contraindicated in clients with which of the following? (Select all that apply.)
- Asthma
- Hypotension
- Constipation
- Coronary artery disease
- Hypertension
Explanation
A. Asthma; B. Hypotension
Explanation
A. Asthma
Nonselective beta blockers block both β₁ and β₂ receptors. Blocking β₂ receptors in the lungs can cause bronchoconstriction, worsening asthma or other respiratory conditions. For this reason, nonselective beta blockers like propranolol are contraindicated in patients with asthma or chronic obstructive pulmonary disease (COPD).
B. Hypotension
Because beta blockers reduce heart rate and cardiac output, they can further lower blood pressure. In patients with existing hypotension, propranolol may cause dangerous drops in blood pressure, dizziness, fainting, or even shock.
A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis?
- Enoxaparin (Clexane/Lovenox) subcutaneous
- Clopidogrel (Plavix)
- Aspirin PO
- Heparin infusion
Explanation
A. Enoxaparin (Clexane/Lovenox) subcutaneous
Explanation
Enoxaparin (Lovenox) is a low molecular weight heparin (LMWH) commonly prescribed for deep vein thrombosis (DVT) prophylaxis after orthopedic surgeries such as hip or knee arthroplasty. It works by inhibiting Factor Xa and reducing clot formation risk without significantly increasing bleeding. It is administered subcutaneously, typically once or twice daily, and does not require continuous IV infusion or frequent lab monitoring like unfractionated heparin.
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