NUA 285 Pharmacotherapeutics at Georgian Court University
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Free NUA 285 Pharmacotherapeutics at Georgian Court University Questions
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 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 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?
- A. Gastrointestinal bleeding
- B. Red man syndrome
- C. Hypertension
- D. 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.
A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions?
- A. Dries mucous membranes
- B. Stimulates secretions
- C. Suppresses the urge to cough
- D. Reduces inflammation
Explanation
B. Stimulates secretions
Explanation
Expectorants, such as guaifenesin, work by stimulating respiratory tract secretions and thinning mucus, making it easier to cough up and clear from the airways. This action helps relieve chest congestion and promotes productive coughing. Unlike antitussives, expectorants do not suppress the cough reflex; instead, they help make coughing more effective by loosening thick or sticky mucus. Adequate hydration enhances the effectiveness of expectorants.
The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient?
- A. "Take a lower dose than normal when you have to drive."
- B. "Take the medication only when you are not driving."
- C. "You may be able to safely take a second-generation antihistamine."
- D. "You are correct: you should not take antihistamines."
Explanation
C. You may be able to safely take a second-generation antihistamine.
Explanation
First-generation antihistamines, such as diphenhydramine (Benadryl), cross the blood-brain barrier and cause sedation, drowsiness, and delayed reaction time, which make them unsafe for individuals who operate heavy machinery or drive professionally. Second-generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra), are nonsedating because they act peripherally without significant central nervous system effects. These are safer options for truck drivers or individuals who need to remain alert while managing allergy symptoms.
A body function that may be affected by a deficiency of vitamin C is:
- A. Synthesis of intrinsic factor
- B. Wound healing
- C. Bowel elimination
- D. Urine formation
Explanation
B. Wound healing
Explanation
Vitamin C (ascorbic acid) is essential for collagen synthesis, which is a key component of connective tissue required for wound healing, tissue repair, and capillary integrity. A deficiency in vitamin C impairs collagen formation, leading to delayed wound healing, fragile blood vessels, and symptoms of scurvy (bleeding gums, bruising, and joint pain). Intrinsic factor relates to vitamin B₁₂ absorption, not vitamin C. Bowel elimination and urine formation are not directly influenced by vitamin C deficiency.
Which of the following medications is most commonly used to treat acute migraine attacks?
- A. Triptans
- B. Antidepressants
- C. Antibiotics
- D. Beta-blockers
Explanation
A. Triptans
Explanation
Triptans, such as sumatriptan and rizatriptan, are the first-line medications for treating acute migraine attacks. They work by stimulating serotonin (5-HT₁) receptors, leading to vasoconstriction of dilated cranial blood vessels and inhibition of inflammatory neuropeptide release. This action helps relieve headache pain, nausea, and sensitivity to light and sound. In contrast, beta-blockers and antidepressants are primarily used for migraine prevention, not for immediate relief of symptoms.
A patient comes to the ER with complaints of shortness of breath, wheezing, an O₂ saturation of 92%, respiratory rate of 28, and heart rate of 110. The patient took a short-acting beta₂ agonist prior to coming to the ER. Which drug will the nurse anticipate administering to the patient first?
- A. Albuterol
- B. Theophylline
- C. Epinephrine
- D. Dexamethasone
Explanation
D. Dexamethasone
Explanation
Because the patient has already used a short-acting beta₂ agonist (such as albuterol) with persistent symptoms, the next step is to administer a systemic corticosteroid, such as dexamethasone. Corticosteroids reduce airway inflammation, decrease mucus production, and enhance the effectiveness of beta₂ agonists. This helps restore airway patency and improve oxygenation. Epinephrine is typically reserved for severe allergic reactions (anaphylaxis), and theophylline is not used for acute asthma exacerbations due to its slow onset and narrow therapeutic range.
An unconscious patient is brought to the emergency department and intubated after respiratory arrest. The patient has a regular pulse. The patient’s spouse suspects an opioid overdose but does not know which drug may have been taken. The nurse will anticipate giving which medication or performing which treatment?
- A. Gastric lavage
- B. Naloxone
- C. Flumazenil
- D. Activated charcoal
Explanation
B. Naloxone
Explanation
Naloxone is the antidote for opioid overdose. It is an opioid antagonist that rapidly reverses the respiratory depression, sedation, and euphoria caused by opioids by displacing them from their receptor sites in the central nervous system. Because the patient is unconscious and intubated following respiratory arrest, immediate administration of naloxone is critical to restore spontaneous respirations and prevent further hypoxia. It can be given IV, IM, or intranasally, and repeated doses may be required due to naloxone’s shorter half-life compared to most opioids.
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?
- A. 2,150 mL
- B. 2,300 mL
- C. 2,050 mL
- D. 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.
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