NUA 285 Pharmacotherapeutics at Georgian Court University
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Free NUA 285 Pharmacotherapeutics at Georgian Court University Questions
A nurse is calculating the intake of a client during the past 9 hr. The client's intake includes lactated Ringer's IV at 125 mL/hr, cefazolin 2 g IV intermittent bolus in 100 mL of 0.9% sodium chloride, two units of packed RBCs of 275 mL and 250 mL, two IV bolus infusions of 250 mL of 0.9% sodium chloride, and ranitidine 50 mg IV intermittent bolus in 50 mL of dextrose 5% in water. How many mL of intake should the nurse record?
- 2,150 mL
- 2,300 mL
- 2,050 mL
- 2,400 mL
Explanation
Lactated Ringer’s: 125 mL/hr × 9 hr = 1,125 mL
Cefazolin in NS: 100 mL
Packed RBCs: 275 mL + 250 mL = 525 mL
Two NS boluses: 250 mL + 250 mL = 500 mL
Ranitidine in D5W: 50 mL
Total intake = 1,125 + 100 + 525 + 500 + 50 = 2,300 mL.
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?
- Metabolic alkalosis
- Kidney stones
- Acute hepatic necrosis
- 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.
What is the primary indication for diltiazem in the management of cardiovascular conditions?
- To treat hypertension and angina
- To prevent thromboembolism
- As an antiarrhythmic agent
- To manage heart failure
Explanation
A. To treat hypertension and angina
Explanation
Diltiazem is a calcium channel blocker (CCB) that works by inhibiting calcium influx into vascular smooth muscle and cardiac cells. This leads to vasodilation, decreased myocardial oxygen demand, and reduced cardiac workload. It is primarily used to treat hypertension and chronic stable or variant angina, improving blood flow to the myocardium and lowering blood pressure.
While diltiazem also has antiarrhythmic properties (used for atrial fibrillation or flutter), its main indication is the management of hypertension and angina. It is not used in heart failure, as it can reduce myocardial contractility and worsen ventricular function in those patients.
The nurse is caring for an older adult patient with a decrease in kidney function. Which of the following laboratory values should the nurse monitor?
- Complete Blood Count
- Creatinine
- Serum Sodium and Potassium
- Serum Albumin
Explanation
B. Creatinine
Explanation
Serum creatinine is a key indicator of kidney function. It reflects how effectively the kidneys filter waste products from the blood. In older adults, decreased renal function can cause creatinine levels to rise, signaling reduced glomerular filtration rate (GFR). Monitoring creatinine helps assess kidney impairment and guides medication dosing to prevent toxicity. Although electrolytes like sodium and potassium may also fluctuate, creatinine remains the most direct measure of renal function.
What parameter should concern the nurse the most in a patient taking digitalis?
- Heart rate of 88 beats per minute and regular
- Heart rate of 52 beats per minute and irregular
- Heart rate of 100 beats per minute and irregular
- Heart rate of 60 beats per minute and regular
Explanation
B. Heart rate of 52 beats per minute and irregular
Explanation
Digitalis (digoxin) slows conduction through the atrioventricular (AV) node and increases the force of myocardial contraction. A heart rate below 60 beats per minute or an irregular rhythm may indicate digitalis toxicity or excessive drug effect. The nurse should withhold the medication and notify the healthcare provider immediately. Signs of digoxin toxicity include bradycardia, irregular pulse, nausea, vomiting, visual disturbances (yellow or green halos), and confusion. The nurse should always check the apical pulse for one full minute before administering digoxin and monitor serum digoxin and potassium levels, as hypokalemia increases toxicity risk.
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?
- Inadequate therapeutic effects
- Excessive adverse effects
- Signs of drug toxicity
- 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 caring for a patient with a history of angina and is treated with a calcium channel blocker. Which of the following would suggest a positive therapeutic response to the medication?
- Absence of chest pain
- Decreased swelling in the ankles and feet
- Patient denies dizziness
- Patient states that she feels stronger
Explanation
A. Absence of chest pain
Explanation
Calcium channel blockers (such as amlodipine, diltiazem, or verapamil) are used to treat angina pectoris by relaxing vascular smooth muscle, causing coronary and peripheral vasodilation. This decreases myocardial oxygen demand and increases oxygen supply to the heart, thereby preventing or relieving chest pain.
A positive therapeutic response is demonstrated by the absence of chest pain and improved exercise tolerance. The nurse should also monitor for adverse effects such as hypotension, dizziness, bradycardia, or peripheral edema, which can occur with prolonged use.
Lisinopril is contraindicated in patients with which adverse condition?
- History of angioedema related to ACE inhibitors
- Asthma
- Chronic sinusitis
- Diabetes mellitus
Explanation
A. History of angioedema related to ACE inhibitors
Explanation
Lisinopril, an ACE inhibitor, is contraindicated in patients with a history of angioedema related to previous ACE inhibitor use. Angioedema is a potentially life-threatening allergic reaction causing rapid swelling of the face, lips, tongue, and airway. Re-exposure to an ACE inhibitor like lisinopril can trigger severe recurrence. While lisinopril can be used cautiously in diabetes and respiratory conditions, a history of angioedema requires absolute avoidance of all ACE inhibitors.
A patient with angina has been given 0.4 mg of nitroglycerin SL. The patient reports continued chest pain 5 minutes later. The nurse assesses a heart rate of 84 beats per minute and a blood pressure of 88/68 mm Hg. The nurse will take which action?
- Notify the provider of the patient’s vital signs
- Give nitroglycerin by translingual spray
- Administer 0.4 mg of nitroglycerin SL
- Administer 0.3 mg of nitroglycerin SL
Explanation
A. Notify the provider of the patient’s vital signs
Explanation
Nitroglycerin causes vasodilation, which can lead to significant hypotension. Since the patient’s blood pressure is already 88/68 mm Hg, administering another dose could cause severe cardiovascular collapse. The nurse should withhold additional nitroglycerin and notify the healthcare provider immediately. The provider may order IV fluids or other interventions to stabilize the patient’s blood pressure.
If the systolic BP were above 90 mm Hg, another SL dose could be safely administered every 5 minutes (up to three total doses). However, in this case, the hypotension makes further dosing unsafe.
The nurse is teaching a client about sucralfate. Which statement made by the patient requires additional teaching?
- "I need to take sucralfate 30 minutes after meals."
- "I need to report pain or vomiting of blood."
- "I need to take my antacid 30 minutes before or 30 minutes after sucralfate."
- "I need to increase my fluid intake."
Explanation
A. "I need to take sucralfate 30 minutes after meals."
Explanation
Sucralfate is a mucosal protectant that forms a barrier over ulcers, protecting them from stomach acid and promoting healing. It must be taken on an empty stomach, typically 1 hour before meals and at bedtime, to be effective. Therefore, the statement about taking it after meals shows a misunderstanding and requires further teaching. Patients should also be instructed to separate sucralfate from antacids by at least 30 minutes, report pain or signs of GI bleeding (vomiting blood, black stools), and increase fluid intake to prevent constipation, a common side effect.
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