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 clinical condition would warrant the administration of diphenhydramine?
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Inflamed nasal cavity
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Constricted bronchioles
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Cough and congestion
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Pulmonary edema
Explanation
Correct Answer: A) Inflamed nasal cavity
Diphenhydramine is a first-generation antihistamine that blocks H1 histamine receptors, making it effective for treating allergic reactions that cause nasal inflammation, such as allergic rhinitis. By blocking histamine, it reduces vasodilation and vascular permeability in the nasal mucosa, relieving inflammation, sneezing, and itching. Constricted bronchioles require a bronchodilator such as albuterol, not an antihistamine. Cough and congestion are better treated with expectorants, decongestants, or antitussives. Pulmonary edema is a serious cardiac or respiratory condition requiring diuretics and other emergency interventions — diphenhydramine has no role in its management.
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?
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2% lipid solution
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Acetylcysteine
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20% lipid solution
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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.
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 receiving an inhaled anesthetic for anesthesia during surgery. The client's body temperature starts to rise, followed by sweating. The nurse recognizes these as early symptoms of which potentially fatal reaction to inhaled anesthetics?
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Malignant hyperthermia
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Red man syndrome
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Local Anesthetic Systemic Toxicity (LAST)
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Stevens-Johnson Syndrome
Explanation
Correct Answer: A) Malignant hyperthermia
Malignant hyperthermia (MH) is a rare but life-threatening pharmacogenetic reaction triggered by exposure to volatile inhaled anesthetic agents (such as halothane, sevoflurane, or desflurane) and succinylcholine. It is caused by a genetic defect in the ryanodine receptor of skeletal muscle, leading to uncontrolled release of calcium from the sarcoplasmic reticulum. This causes sustained, uncontrolled skeletal muscle contractions resulting in a dramatic rise in body temperature (often exceeding 40°C), profuse sweating, muscle rigidity, tachycardia, and severe metabolic acidosis. Early recognition is critical — the treatment is immediate discontinuation of the triggering agent and administration of dantrolene sodium, the only specific antidote for malignant hyperthermia.
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 __________.
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Steady state
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Minimum effective concentration
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Toxic concentration
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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.
Which statement correctly describes one of the advantages of oral drug administration?
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Systemic side effects are less common than other routes
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Simple and cheap when compared to other routes
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100% of the dose is always received by the patient
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Drug action occurs rapidly with this route
Explanation
Correct Answer: B) Simple and cheap when compared to other routes
The oral route is the most commonly used route of drug administration because it is convenient, non-invasive, painless, and significantly less expensive than parenteral routes which require sterile equipment, syringes, and trained personnel.
Option A is incorrect — systemic side effects are still common with oral medications as they are absorbed into the bloodstream. Option C is incorrect because oral drugs are subject to the first-pass effect and variable absorption, meaning the full dose is never guaranteed to reach systemic circulation.
Option D is incorrect because oral drugs have a slower onset of action compared to IV or inhaled routes due to the time required for absorption through the GI tract.
Which statement correctly describes pharmacodynamics?
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How drugs move throughout the body
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How the drug gets into the bloodstream
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The process of changing active drug into inactive metabolites
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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.
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.
Which is a "Right of Medication Administration?" Select all that apply.
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Right provider
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Right patient
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Right medication
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Right dose
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Right time
Explanation
Correct Answers: B) Right patient, C) Right medication, D) Right dose, E) Right time
The Rights of Medication Administration are a foundational safety framework used by nurses to prevent medication errors. The classic "Five Rights" include: Right patient (verifying identity using two identifiers), Right medication (confirming the correct drug is being given), Right dose (ensuring the prescribed amount is accurate), Right time (administering at the correct scheduled time), and Right route. "Right provider" is not one of the established rights of medication administration — it is the responsibility of the prescriber to order medications, but it is not included in the standard rights framework used at the point of care.
Which IV fluid should be used for a patient with increased intracranial pressure to pull fluid out of swollen brain cells?
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D5W
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0.9% NS
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Lactated Ringers
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3% Saline
Explanation
Correct Answer: D) 3% Saline 3%
Saline is a hypertonic solution, meaning it has a higher osmolarity than body fluids. When administered, it creates an osmotic gradient that draws fluid out of swollen brain cells and into the bloodstream, effectively reducing cerebral edema and decreasing intracranial pressure. D5W is a hypotonic solution that actually moves fluid into cells, making it contraindicated in patients with increased intracranial pressure. 0.9% NS is isotonic and is primarily used for volume replacement and blood administration compatibility. Lactated Ringers, while also isotonic, is used with caution in liver disease patients due to its lactate content and is not indicated for managing intracranial pressure.
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