Texas Woman's University Dallas Pharm Exam 1 SP26
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Free Texas Woman's University Dallas Pharm Exam 1 SP26 Questions
A client presents to the Emergency Department with gastrointestinal bleeding. The family has brought a bag of the client's medications to the hospital. Upon reviewing the client's medications, which could be responsible for the GI bleeding? Select all that apply.
- Allopurinol
- Acetaminophen
- Ibuprofen
- Meloxicam
- Sumatriptan
Explanation
Correct Answers: C) Ibuprofen and D) Meloxicam Ibuprofen and Meloxicam are both NSAIDs (nonsteroidal anti-inflammatory drugs) that inhibit cyclooxygenase (COX) enzymes, reducing the production of prostaglandins that normally protect the gastric mucosa. Without this protective lining, the stomach becomes vulnerable to erosion and GI bleeding. Allopurinol is used for gout and does not cause GI bleeding. Acetaminophen works differently from NSAIDs and does not inhibit prostaglandin synthesis in the gastric mucosa, making it the preferred analgesic for patients at risk of GI bleeding. Sumatriptan is a triptan used for migraines and does not carry a risk of GI bleeding.
A client presents to the emergency department with an acute gout flare. The big toe is inflamed, and crystallization is present. Which medication will decrease the inflammation?
- Morphine sulfate
- Allopurinol
- Colchicine
- Acetaminophen
Explanation
Correct Answer: C) Colchicine
Colchicine is the drug of choice for treating acute gout flares because it works by inhibiting the migration of neutrophils to the affected joint, thereby reducing the inflammatory response triggered by uric acid crystal deposition. It directly targets the mechanism of gout-related inflammation. Allopurinol is used for long-term prevention of gout by reducing uric acid production, but it is not used during an acute flare as it can actually worsen the attack if initiated at this time. Morphine sulfate is an opioid analgesic that addresses pain but does not treat the underlying inflammation. Acetaminophen provides mild pain relief but has no anti-inflammatory properties and does not address the crystallization-driven inflammatory process in gout.
A client has been started on an antihypertensive medication. Ideally, a client will be able to maintain a constant serum drug level of this medication. This is referred to as the __________.
- Steady state
- Minimum effective concentration
- Toxic concentration
- Half-life
Explanation
Correct Answer: A) Steady state
Steady state refers to the condition in which the rate of drug administration equals the rate of drug elimination, resulting in a constant and stable serum drug concentration over time. For antihypertensive medications, maintaining steady state is the therapeutic goal because it ensures consistent blood pressure control without dangerous peaks or drops.
It is typically reached after approximately 4 to 5 half-lives of consistent dosing. Minimum effective concentration is the lowest drug level needed to produce a therapeutic effect. Toxic concentration is the drug level at which harmful effects begin to occur.
Half-life is the time required for the drug concentration to decrease by 50% and is used to determine dosing intervals, not the state of constant drug levels.
A client has been receiving bupivacaine for localized pain relief. The client begins to report a metallic taste and is becoming increasingly agitated. Which can be used to treat this condition?
- 2% lipid solution
- Acetylcysteine
- 20% lipid solution
- Propofol
Explanation
Correct Answer: C) 20% lipid solution
The symptoms described — metallic taste and agitation following bupivacaine administration — are classic early signs of Local Anesthetic Systemic Toxicity (LAST). This occurs when local anesthetics like bupivacaine enter the systemic circulation, causing CNS and cardiovascular toxicity. The first-line treatment for LAST is 20% intravenous lipid emulsion (Intralipid). It works by acting as a "lipid sink," binding the lipid-soluble anesthetic and drawing it away from cardiac and neural tissues. A 2% lipid solution is not the correct concentration — the standard rescue dose requires the 20% formulation.
Which statement correctly describes pharmacodynamics?
- How drugs move throughout the body
- How the drug gets into the bloodstream
- The process of changing active drug into inactive metabolites
- What the drug does to the body to cause an effect
Explanation
Correct Answer: D) What the drug does to the body to cause an effect
Pharmacodynamics refers to the study of what a drug does to the body — including its mechanism of action, receptor binding, and the physiological and biochemical effects it produces. Option A describes pharmacokinetics, specifically distribution. Option B describes absorption, which is also a component of pharmacokinetics. Option C describes drug metabolism (biotransformation), another pharmacokinetic process. A simple way to remember the distinction is: pharmacokinetics is what the body does to the drug (absorption, distribution, metabolism, excretion), while pharmacodynamics is what the drug does to the body.
Which medication order is written correctly?
- Morphine 1-2 mg IV every 6 hours for pain
- Morphine 2 mg IV every 4-6 hours for pain level 5-7
- Morphine 1 mg every 6 hours for pain level 5 or more
- Morphine 2 mg IV every 6 hours for pain level 7-9
Explanation
Correct Answer: D) Morphine 2 mg IV every 6 hours for pain level 7-9
A correctly written medication order must include the drug name, dose, route, frequency, and a specific indication or parameter. Option D is correct because it includes all required components — a fixed dose (2 mg), a clearly defined route (IV), a set frequency (every 6 hours), and a specific pain level range (7-9) that guides when the medication should be administered.
A client's lab report has just come in. The client's Creatinine Clearance (CrCl) is 25 mL/min (normal 120 mL/min for men and 95 mL/min for women). What has the nurse learned from this information?
- The client has poor liver function
- The client must be elderly
- The client has poor renal function
- The client likely abuses alcohol
Explanation
Correct Answer: C) The client has poor renal function
Creatinine Clearance (CrCl) is a laboratory measurement used to estimate the glomerular filtration rate (GFR) and assess how well the kidneys are filtering waste from the blood. A CrCl of 25 mL/min is significantly below the normal range, indicating severely impaired renal function. This is a critical finding for medication management because drugs that are renally excreted will accumulate in the body, increasing the risk of toxicity — dose adjustments or alternative medications may be needed. CrCl does not reflect liver function, which is assessed through liver function tests such as ALT, AST, and bilirubin. While renal function does decline with age, a low CrCl alone does not confirm the client is elderly, and it has no relation to alcohol use.
Which is responsible for the lower bioavailability seen in oral drugs?
- First-Pass Effect
- Distribution
- Peripherally Inserted Central Catheter
- Half-Life
Explanation
Correct Answer: A) First-Pass Effect
The first-pass effect refers to the metabolism of an orally administered drug by the liver before it reaches systemic circulation. After absorption in the gastrointestinal tract, oral drugs are transported via the portal vein directly to the liver, where hepatic enzymes break down a significant portion of the drug, reducing the amount that ultimately reaches the bloodstream and target tissues.
This is why oral drugs often have lower bioavailability compared to IV or other routes that bypass the liver. Distribution refers to how a drug spreads throughout the body after absorption and does not reduce bioavailability. A PICC line is a vascular access device, not a pharmacokinetic process. Half-life describes the rate of drug elimination, not initial bioavailability.
A new client presents for surgery. Which finding during the patient assessment would cause the nurse to question the use of propofol?
- Family history of malignant hyperthermia
- An egg or soy allergy
- Post-operative nausea and vomiting at last surgery
- History of muscular dystrophy
Explanation
Correct Answer: B) An egg or soy allergy
Propofol is formulated in a lipid emulsion that contains soybean oil, glycerol, and egg lecithin. Patients with a known allergy to eggs or soy are at risk for a hypersensitivity reaction to propofol, making this finding a critical contraindication that the nurse must report before administration.
Family history of malignant hyperthermia is a concern with volatile inhaled anesthetic agents and succinylcholine, not propofol. Post-operative nausea and vomiting from a prior surgery is actually a reason propofol may be preferred, as it has antiemetic properties. History of muscular dystrophy is a concern with succinylcholine, not propofol.
A patient is receiving an infusion of morphine sulfate for pain relief, but their pain is not completely controlled. The addition of diazepam has been ordered for this patient. The nurse questions this order because which severe side effect of opioids is more likely to occur if taken with diazepam?
- Ergotamine tartrate
- Acetaminophen, aspirin, caffeine
- Sumatriptan
- Sumatriptan and naproxen
Explanation
Correct Answer: D) Respiratory depression
When opioids such as morphine sulfate are combined with benzodiazepines such as diazepam, there is a significantly increased risk of severe respiratory depression, which can be life-threatening. Both drug classes act as CNS depressants — opioids suppress respiratory drive by acting on mu receptors in the brainstem, while benzodiazepines enhance GABA-mediated CNS inhibition. Their combined effect synergistically depresses the respiratory center, potentially causing apnea and death. This combination carries a Black Box Warning from the FDA. The nurse is right to question this order and ensure the prescriber is aware of the patient's current opioid therapy before adding a benzodiazepine.
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