NUA 285 Pharmacotherapeutics
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A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient’s tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action?
- A. Rinse the mouth thoroughly with water after each use.
- B. Consume yogurt daily while using this medication.
- C. Avoid using a spacer with the inhaled glucocorticoid medication.
- D. Clean the inhaler with hot soapy water after each use.
Explanation
A. Rinse the mouth thoroughly with water after each use.
Explanation
Inhaled glucocorticoids (such as fluticasone or budesonide) can cause oral candidiasis (thrush), a fungal infection that appears as white patches on the tongue and mucous membranes. Rinsing the mouth and gargling with water after each use removes residual medication, preventing fungal growth. Using a spacer with a metered-dose inhaler also helps reduce oropharyngeal deposition of the steroid. The nurse should educate the patient that this infection is preventable and to contact the provider if symptoms persist despite proper oral hygiene.
The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL. What will the nurse expect the patient to experience?
- A. Inadequate therapeutic effects
- B. Excessive adverse effects
- C. Signs of drug toxicity
- D. Increased risk for superinfection
Explanation
A. Inadequate therapeutic effects
Explanation
A trough level measures the lowest concentration of a drug in the bloodstream, indicating whether the dose is sufficient to maintain a therapeutic effect. A trough level below the normal range (1.5 mcg/mL vs. the desired 1.7–2.2 mcg/mL) suggests that the drug concentration is too low to effectively combat infection. This may lead to ineffective treatment, persistence of the infection, and potential antibiotic resistance. In contrast, levels above the therapeutic range increase the risk of toxicity or adverse effects. The nurse should report this result to the provider, as a dosage adjustment or shorter dosing interval may be required.
The nurse is administering amiodarone to a patient who is being treated for a ventricular arrhythmia. The patient has received a bolus of 150 mg of amiodarone IV and is now receiving a continuous infusion of 1 mg/min. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 88/54 mm Hg. The nurse will notify the provider and perform which other action?
- A. Continue the amiodarone infusion at 1 mg/min.
- B. Increase the rate of the amiodarone infusion to 1.5 mg/min.
- C. Decrease the rate of the amiodarone infusion to 0.5 mg/min.
- D. Stop the infusion of amiodarone.
Explanation
D. Stop the infusion of amiodarone.
Explanation
Amiodarone is an antiarrhythmic medication that can cause bradycardia and hypotension as significant adverse effects, especially when given intravenously. The patient’s heart rate of 60 bpm and blood pressure of 88/54 mm Hg indicate the development of symptomatic bradycardia and hypotension, requiring immediate action. The nurse should stop the infusion immediately and notify the healthcare provider. Supportive measures such as IV fluids or vasopressors may be required to stabilize the blood pressure. Restarting or reducing the infusion should only occur under direct provider guidance once the patient’s hemodynamic status stabilizes.
Mr. Johnson, a 57-year-old male. was recently diagnosed with severe allergic asthma. His provider prescribes prednisone (a corticosteroid) to reduce inflammation and improve his breathing. He has been instructed to take 40 mg orally daily for the next 5 days, followed by a gradual taper. During the course of treatment. Mr. Johnson reports feeling increasingly fatigued, experiencing swelling in his legs, and noticing a weight gain of 3 pounds over the last 3 days. He also mentions having difficulty sleeping. What is the nurse's primary concern regarding Mr. Johnson's symptoms (fatigue, swelling, weight gain, difficulty sleeping) while on prednisone therapy?
- A. These symptoms are signs of an allergic reaction to the medication.
- B. These are expected side effects of short-term corticosteroid use.
- C. These symptoms may indicate fluid retention and potential electrolyte imbalances.
- D. These symptoms are due to an underlying infection caused by the medication.
Explanation
C. These symptoms may indicate fluid retention and potential electrolyte imbalances.
Explanation
Prednisone, a corticosteroid, can cause sodium and water retention, leading to edema, rapid weight gain, and hypertension. The fatigue Mr. Johnson reports may be related to electrolyte imbalances, such as hypokalemia or hypernatremia, which are common with corticosteroid use. Difficulty sleeping is also a frequent side effect due to prednisone’s stimulatory effect on the central nervous system. The nurse’s primary concern is to monitor for signs of fluid overload and electrolyte disturbances, which can worsen cardiovascular strain. Patient education should include monitoring daily weights, limiting sodium intake, reporting swelling or shortness of breath, and taking the medication in the morning to reduce insomnia.
A patient who has recently begun taking captopril (Capoten) to treat hypertension calls a clinic to report a persistent cough. The nurse will perform which action?
- A. Instruct the patient to go to an emergency department because this is a hypersensitivity reaction.
- B. Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB).
- C. Tell the patient to stop taking the drug immediately since this is a serious side effect of this drug.
- D. Reassure the patient that this side effect is nothing to worry about and will diminish over time.
Explanation
B. Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB).
Explanation
A persistent, dry cough is a common and well-known side effect of ACE inhibitors such as captopril. It occurs due to the accumulation of bradykinin and substance P in the respiratory tract. While not dangerous, the cough can be bothersome and affect compliance. The nurse should advise the patient not to stop the medication abruptly but to contact the healthcare provider. The provider will likely switch the patient to an angiotensin II receptor blocker (ARB) such as losartan or valsartan, which provides similar blood pressure control without causing cough.
A client is receiving furosemide (Lasix). The nurse should monitor for which adverse effect of the medication?
- A. Nausea
- B. Increased urinary output
- C. Dizziness and lightheadedness
- D. Gastric upset
Explanation
C. Dizziness and lightheadedness
Explanation
Furosemide (Lasix) is a loop diuretic that promotes rapid excretion of sodium and water, reducing blood volume. This can lead to hypotension and electrolyte imbalances, particularly hypokalemia. Dizziness and lightheadedness are common adverse effects caused by decreased blood pressure and fluid loss. The nurse should monitor the client’s blood pressure, electrolyte levels, and hydration status, and advise the client to rise slowly from sitting or lying positions to prevent falls.
A patient has been admitted after overdosing on acetaminophen. The nurse plans to monitor this patient for development of which complication related to the overdose?
- A. Metabolic alkalosis
- B. Kidney stones
- C. Acute hepatic necrosis
- D. Decreased urinary output
Explanation
C. Acute hepatic necrosis
Explanation
An acetaminophen overdose primarily affects the liver, leading to acute hepatic necrosis due to toxic metabolite accumulation (NAPQI). This metabolite depletes glutathione, damaging liver cells and causing potentially fatal liver failure. Early symptoms include nausea, vomiting, and right upper quadrant pain, followed by jaundice and elevated liver enzymes. The nurse should closely monitor liver function tests (AST, ALT, bilirubin) and coagulation profiles. The antidote, acetylcysteine (Mucomyst), should be administered promptly to prevent or minimize liver damage by replenishing glutathione stores.
A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer
- A. Glucagon
- B. Orange juice
- C. Insulin
- D. Cardiopulmonary resuscitation (CPR)
Explanation
A. Glucagon
Explanation
An unconscious patient with type 1 diabetes mellitus is likely experiencing severe hypoglycemia. Because the patient cannot safely take oral glucose (like orange juice), glucagon should be administered intramuscularly or subcutaneously to rapidly raise blood glucose levels. Glucagon stimulates the liver to convert stored glycogen into glucose and release it into the bloodstream. Once the patient regains consciousness, an oral carbohydrate source can be given to maintain normal blood glucose levels.
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.
- A. Beta-adrenergic
- B. Alpha-adrenergic
- C. Dopamine
- D. 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.
What is a potential serious complication of abrupt cessation of beta-blockers like metoprolol?
- A. Rebound hypertension
- B. Sedation
- C. Hypoglycemia
- D. Hyperkalemia
Explanation
A. Rebound hypertension
Explanation
Abruptly stopping beta-blockers such as metoprolol can cause rebound hypertension, tachycardia, and even angina or myocardial infarction in patients with heart disease. This occurs because beta-blockers suppress sympathetic nervous system activity; sudden withdrawal leads to overstimulation of beta receptors. To prevent this dangerous effect, beta-blockers should always be tapered gradually under medical supervision while monitoring blood pressure and heart rate closely.
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