Texas Woman's University Dallas Pharm Exam 1 SP26
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Free Texas Woman's University Dallas Pharm Exam 1 SP26 Questions
Which of the following headache treatment options has Black Box Warnings for cardiovascular risk and for gastrointestinal bleeding risk?
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Ergotamine tartrate
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Acetaminophen, aspirin, caffeine
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Sumatriptan
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Sumatriptan and naproxen
Explanation
Correct Answer: D) Sumatriptan and naproxen
The combination product of sumatriptan and naproxen (Treximet) carries Black Box Warnings for both cardiovascular risk and gastrointestinal bleeding risk. Naproxen is an NSAID that carries a Black Box Warning for increased risk of serious cardiovascular thrombotic events and GI bleeding, ulceration, and perforation. Sumatriptan is a triptan that carries cardiovascular warnings due to its vasoconstrictive properties. Together, this combination product carries both warnings. Ergotamine tartrate carries warnings related to vasospasm and ergotism. Acetaminophen, aspirin, and caffeine combination carries a warning for liver damage with acetaminophen overuse. Sumatriptan alone does not carry a GI bleeding warning.
A 70 year old client is receiving a continuous infusion of IV morphine sulfate to help manage severe chronic pain during their hospital stay. Upon examination, the client is more lethargic than usual and the nurse observes a significantly lower respiration rate (breaths per minute). Which of the following actions, potential condition, and parameters to monitor are appropriate for this client? Select all that apply.
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Stop the morphine infusion
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Review the patient's allergy list
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Prepare to administer naloxone
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Prepare to administer acetylcysteine
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Gastrointestinal (GI) bleeding
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Opioid overdose
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Local anesthetic systemic toxicity (LAST)
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Malignant hyperthermia
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Signs of withdrawal
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Improved respiration rate (breaths per minute)
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Reduced blood in stools
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Cooling of body temperature
Explanation
Correct Answers: Action to Take: A) Stop the morphine infusion and C) Prepare to administer naloxone | Potential Condition: B) Opioid overdose | Parameter to Monitor: B) Improved respiration rate (breaths per minute)
The clinical picture of lethargy and significantly reduced respiration rate in a patient receiving IV morphine is consistent with opioid overdose. The priority nursing actions are to immediately stop the morphine infusion to prevent further opioid accumulation, and to prepare to administer naloxone, which is the specific opioid antagonist that reverses opioid-induced respiratory depression by competitively blocking opioid receptors. Acetylcysteine is the antidote for acetaminophen toxicity and is not relevant here. After naloxone administration, the primary parameter to monitor is improved respiration rate, as this confirms the reversal of opioid toxicity is effective. Signs of withdrawal may occur as a side effect of naloxone but are not the primary therapeutic goal. GI bleeding, LAST, and malignant hyperthermia are unrelated to the presenting symptoms.
A nurse administered a bolus of normal saline to an elderly patient. After administration the patient begins complaining of shortness of breath, has bounding pulses, and crackles in all lung fields upon auscultation. The patient's vital signs are: HR 120 & Bounding, RR 28, BP 160/90, Temperature 97.9 Temporal, SpO2 87% on Room Air. What adverse effect does the nurse suspect?
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Fluid Volume Overload
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Fluid Volume Deficit
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Hypokalemia
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Hypernatremia
Explanation
Correct Answer: A) Fluid Volume Overload
The clinical picture of shortness of breath, bounding tachycardia (HR 120), hypertension (BP 160/90), elevated respiratory rate (RR 28), low oxygen saturation (SpO2 87%), and crackles in all lung fields immediately following a normal saline bolus are classic signs of fluid volume overload (hypervolemia). Elderly patients are especially vulnerable because aging reduces both cardiac and renal reserve, impairing the body's ability to compensate for rapid fluid administration.
The excess fluid shifts into the pulmonary interstitium and alveoli causing pulmonary edema, evidenced by bilateral crackles on auscultation. The bounding pulse and hypertension result from the expanded intravascular volume increasing cardiac workload and stroke volume. Fluid volume deficit would instead present with hypotension, weak thready pulse, and signs of dehydration.
Hypokalemia and hypernatremia are electrolyte disturbances that do not produce this specific constellation of cardiovascular and respiratory findings following fluid administration.
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.
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Allopurinol
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Acetaminophen
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Ibuprofen
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Meloxicam
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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.
The nurse is preparing to administer a dose of acetylcysteine. Which of the following are indications for this drug? Select all that apply.
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Mucolysis
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Acetaminophen overdose
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Eosinophilic asthma
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Hyperthyroidism
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Seasonal allergies
Explanation
Correct Answers: A) Mucolysis and B) Acetaminophen overdose
Acetylcysteine has two primary clinical indications. First, it is used as a mucolytic agent — it breaks down disulfide bonds in mucus glycoproteins, thinning and loosening thick secretions in conditions such as COPD, cystic fibrosis, and pneumonia to facilitate airway clearance. Second, it is the specific antidote for acetaminophen overdose — it works by replenishing glutathione stores in the liver, which neutralizes the toxic metabolite NAPQI and prevents hepatotoxicity. Eosinophilic asthma is treated with biologics such as mepolizumab. Hyperthyroidism is managed with antithyroid medications such as methimazole. Seasonal allergies are treated with antihistamines or corticosteroids. None of these conditions are indications for acetylcysteine.
Which medication order is written correctly?
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Morphine 1-2 mg IV every 6 hours for pain
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Morphine 2 mg IV every 4-6 hours for pain level 5-7
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Morphine 1 mg every 6 hours for pain level 5 or more
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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?
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The client has poor liver function
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The client must be elderly
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The client has poor renal function
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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 statement correctly describes an important nursing consideration when treating elderly clients?
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Elderly clients become "ultrarapid metabolizers" of all CYP enzymes
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This client population consists of people 50 years of age and older
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Drugs tend to stay in the body longer
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Elderly clients will always have poor renal function
Explanation
Correct Answer: C) Drugs tend to stay in the body longer
In elderly clients, physiological changes associated with aging — including decreased hepatic blood flow, reduced kidney function, decreased lean body mass, and lower total body water — result in slower drug metabolism and excretion. As a result, drugs tend to accumulate and stay in the body longer, increasing the risk of toxicity and adverse effects. Elderly clients are generally slower metabolizers, not ultrarapid metabolizers, of CYP enzymes. The elderly population is typically defined as 65 years of age and older, not 50. While renal function commonly declines with age, it does not always result in poor function in every elderly client — it varies by individual.
A client diagnosed with asthma is prescribed an inhaled corticosteroid. Which should the nurse include in the client education? Select all that apply.
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"During an acute asthma attack use your corticosteroid first."
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"During an acute asthma attack use your albuterol inhaler first."
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"Report white patches in your mouth to your provider."
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"Tachycardia and nervousness is an expected adverse effect."
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"Rinse your mouth after using your inhaler."
Explanation
Correct Answers: B) "During an acute asthma attack use your albuterol inhaler first," C) "Report white patches in your mouth to your provider," and E) "Rinse your mouth after using your inhaler"
Inhaled corticosteroids (ICS) such as fluticasone or budesonide are long-term controller medications, not rescue inhalers. During an acute asthma attack, the client should use albuterol (a short-acting beta-2 agonist) first for immediate bronchodilation. A key side effect of inhaled corticosteroids is oral candidiasis (thrush), which presents as white patches in the mouth caused by the steroid suppressing local immune defenses — this must be reported to the provider. To prevent oral candidiasis, clients should always rinse their mouth with water and spit after each use of their inhaled corticosteroid. Tachycardia and nervousness are adverse effects associated with albuterol, not inhaled corticosteroids.
A client is instructed to take pseudoephedrine for nasal congestion symptoms. The nurse teaching about this drug knows that this is appropriate because the therapeutic effect for pseudoephedrine is:
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Increased blood pressure
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Increased heart rate
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Decrease production of mucus
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Improved nasal drainage
Explanation
Correct Answer: D) Improved nasal drainage
Pseudoephedrine is a sympathomimetic decongestant that works by stimulating alpha-adrenergic receptors in the nasal mucosa, causing vasoconstriction of the nasal blood vessels. This reduces swelling of the nasal passages and promotes improved nasal drainage, which directly relieves nasal congestion. While pseudoephedrine can cause increased blood pressure and heart rate as side effects due to its sympathomimetic properties, these are adverse effects, not the intended therapeutic outcomes. It does not decrease mucus production — that is the mechanism of antihistamines or anticholinergic agents.
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