NR-293 Pharmacology for Nursing Practice - Set 1 - Part 1

Correct Answer: Contact the prescriber to clarify the route

A complete order names drug, dose, route, frequency, and form. Selecting a route is prescribing, which sits outside nursing scope, so the nurse calls the prescriber and has the missing element supplied. Option a is incorrect because choosing the vascular path without an order is an independent prescribing decision. This particular drug also causes severe tissue injury if it escapes the vein, making the choice riskier still. Option b is incorrect because substituting a deep muscle injection still supplies a route the prescriber never specified. Nurses may not fill that blank themselves, however reasonable the substitute appears for a vomiting client. Option d is incorrect because delaying treatment leaves symptoms untreated while the gap in the order stays unresolved. Passing an incomplete order to the oncoming nurse also transfers a hazard rather than removing it.

Correct Answer: Take the dose right after a feeding

Dosing immediately after nursing, or before the infant's longest sleep stretch, places the milk concentration peak in the interval between feeds. The level has fallen again by the time the baby next feeds. Option b is incorrect because swallowing a dose moments before nursing lines the feed up with rising drug levels. The infant then receives milk at close to the highest concentration the mother produces. Option c is incorrect because routine discarding of expressed milk is reserved for a small group of genuinely hazardous agents. Applying it broadly wastes milk, threatens supply, and was never the question asked. Option d is incorrect because abandoning nursing sacrifices immune and nutritional benefits when timing alone usually suffices. Most drugs are compatible with lactation, and a blanket instruction to wean exceeds what this situation requires.

Correct Answer: Reporting bruising noticed during the morning bath

Observing and reporting is within the assistant's role. Noticing bruising during hygiene and telling the nurse supports monitoring of a high alert anticoagulant, while judgement about the finding stays with the nurse. Option a is incorrect because titrating an anticoagulant against coagulation values demands clinical judgement and a licence. Assistive personnel do not interpret laboratory data or alter therapy, and heparin sits on the high alert list. Option b is incorrect because client education is a nursing intervention requiring assessment of readiness and evaluation of understanding. Teaching cannot be handed to staff who are not licensed to assess what the client already knows. Option d is incorrect because an independent double check must be performed by a second licensed provider. The whole point of that safeguard is a qualified clinician confirming the calculation, concentration, and pump settings.

Correct Answer: Suction the airway and apply oxygen

Respiratory failure from secretions and weak muscles kills in cholinergic crisis, so clearing the airway and oxygenating come before every other step. Atropine and provider notification follow once breathing is supported. Option b is incorrect because atropine dries the secretions but does nothing for the airway already filled with them. The drug is given right after the airway is cleared, not ahead of it. Option c is incorrect because grip strength documents the neurologic baseline for later comparison. Gathering data of that kind belongs after the client is breathing safely, not while the airway is drowning in fluid. Option d is incorrect because a phone call moves nothing out of the trachea. Bradycardia here is one piece of a muscarinic overload picture the nurse must first treat at the bedside.

Correct Answer: The second nurse must independently recheck everything

An independent double check means the second licensed provider separately reads the order, inspects the vial concentration, and reads the syringe markings without being told the answer. A distracted glance provides none of that. Option a is incorrect because a glance from a distance while multitasking is not the safeguard the policy describes. Insulin errors cause profound hypoglycemia, and only a genuine second look catches a tenfold slip. Option b is incorrect because signing a record documents that verification happened, which is not the same as performing it. A signature attached to no real review creates a false trail and no protection. Option c is incorrect because this hormone sits squarely on the standard high alert list. Facilities require another licensed provider to confirm the dose precisely because a small numerical error can be fatal within minutes.

Correct Answer: Expiratory wheezing with chest tightness

Cholinergic stimulation narrows the bronchi and thickens secretions, which is dangerous in reactive airways. Wheezing with chest tightness threatens ventilation and must reach the provider before the next dose is given. Option a is incorrect because diaphoresis is a predictable glandular effect of turning up parasympathetic activity. Damp skin is uncomfortable and worth documenting, yet it poses no threat to the airway or the circulation. Option b is incorrect because the urge to urinate is the therapeutic result the drug was ordered to produce. The nurse should have a urinal ready and record the amount the client passes. Option d is incorrect because tearing and salivation sit squarely inside the expected picture of muscarinic stimulation. Both belong to the familiar cluster this class produces and neither one endangers breathing or perfusion.

Correct Answer: Vasoconstriction, urinary retention and pupil dilation

Alpha one receptors sit on vascular smooth muscle, the bladder neck and the iris dilator muscle. Stimulation therefore narrows vessels and raises pressure, tightens the bladder outlet and widens the pupil. Option b is incorrect because that cluster describes beta two activity in the lungs, uterus and liver. Alpha one receptors are absent from bronchial smooth muscle, so airway caliber is unchanged by this drug. Option c is incorrect because slowing, wet secretions and small pupils are parasympathetic findings driven by acetylcholine. Stimulating an adrenergic receptor cannot generate the rest and digest picture described here. Option d is incorrect because renin release and enhanced rate, conduction and force belong to beta one receptors in the heart and kidney. A pure vasoconstrictor works on vessels, not on cardiac tissue.

Correct Answer: Severe eye pain with halos around lights

Mydriasis pushes the iris against the drainage angle and blocks aqueous outflow, so pressure inside the eye climbs fast. Eye pain with halos points to acute angle closure, which can destroy vision. Option a is incorrect because sedation is a well known effect of scopolamine crossing into the brain. Sleepiness that lifts with rest is a nuisance the client can plan around during the trip. Option b is incorrect because reduced salivary flow follows directly from muscarinic blockade and shows the patch is working. Frequent sips and sugar free candy handle it without any call to the provider. Option d is incorrect because slowed bowel transit develops in many clients using this patch. Hard stools call for fluid, fiber and movement, and only an absence of bowel sounds would raise concern.

Correct Answer: Hold the dose and contact the prescriber

Anticholinergic drugs work against the acetylcholine this client already lacks, so weakness can deepen and pneumonia raises the respiratory risk further. The nurse withholds the dose and calls the prescriber. Option a is incorrect because giving the drug first and watching afterward exposes a client whose respiratory muscles are already threatened by infection. Bowel sounds would not warn of the weakness that matters here. Option b is incorrect because water changes nothing about a pharmacologic conflict. Swallowing is itself unsafe when bulbar muscles weaken, and a large volume of fluid raises the chance of aspiration in this client. Option c is incorrect because timing around food solves a stomach upset problem, not a receptor problem. Delaying the dose by an hour leaves the same drug blocking the same transmission once it is absorbed.

Correct Answer: Salivation, tearing, cramping and a slow pulse

Stimulating muscarinic receptors turns up rest and digest activity. Glands pour out saliva and tears, the gut cramps and moves, and vagal tone on the sinus node drops the heart rate. Option b is incorrect because a dry, flushed, tachycardic client shows muscarinic receptors being blocked. That toxidrome belongs to atropine and its relatives, and it is the mirror image of cholinergic stimulation. Option c is incorrect because mydriasis, slowed bowel transit and skin that cannot sweat all follow from cholinergic blockade. A cholinergic agonist narrows the pupil and leaves the client damp instead. Option d is incorrect because widened airways, held urine and less stomach acid describe what happens when acetylcholine is prevented from acting. Agonists narrow the airway, empty the bladder and raise gastric secretion.

Correct Answer: Stop the infusion and leave the catheter in place

Extravasation of a vasopressor causes tissue necrosis, so the infusion stops at once. The catheter stays in so residual drug can be aspirated and phentolamine infiltrated through it before removal. Option a is incorrect because reducing the rate still delivers a potent vasoconstrictor into the tissue, and an hour of waiting allows necrosis to advance. Blanching demands immediate interruption of the drug. Option c is incorrect because pulling the catheter too soon discards the route used to aspirate residual drug and deliver the antidote. Elevation helps, but it follows rather than replaces those steps. Option d is incorrect because cold worsens the vasoconstriction already strangling the tissue, and continuing the ordered rate pushes more drug into the area. Warm compresses, not ice, are used after the drug stops.

Correct Answer: The drug skips the absorption step entirely

Medication placed directly into a vein is already in the circulation, so bioavailability is complete and nothing has to be absorbed. That is why the intravenous route is chosen in an emergency. Option a is incorrect because binding to plasma protein actually holds drug in an inactive reserve and slows the onset of effect. Route selection does not change how tightly a molecule sticks to albumin. Option b is incorrect because injected drugs escape only the first pass through the portal circulation. The liver still metabolises them afterward, which is why hepatic impairment matters even for parenteral orders. Option c is incorrect because slower elimination would prolong an effect rather than start it sooner. Speed of onset belongs to how quickly drug enters the blood, not to how long it lingers.

Correct Answer: Prolonged use has caused rebound nasal congestion

Topical alpha one agonists shrink nasal vessels, but use beyond three to five days leads to rebound swelling once the drug wears off. The remedy is stopping the spray, not using more. Option a is incorrect because bacterial sinusitis brings fever, facial pain and purulent drainage, none of which this client describes. The pattern here follows the dosing history rather than an infectious process. Option b is incorrect because loss of potency would produce no effect at all, not a worsening of the original symptom. Rebound swelling is an active vascular response to repeated alpha stimulation. Option d is incorrect because an allergic response typically brings itching, sneezing, rash or airway involvement alongside congestion. Nothing described points to hypersensitivity, and the timing matches overuse of the decongestant.

Correct Answer: "I will switch to orange juice with my breakfast."

Grapefruit blocks the enzyme that clears this statin, so drug levels climb and muscle and liver injury become more likely. Choosing another juice removes the interaction without changing the prescription. Option b is incorrect because separating the two by a few hours does not help, since enzyme blockade lasts far longer than the juice stays in the stomach. Spacing works for chelation, not this. Option c is incorrect because more juice pushes the statin level even higher and multiplies the danger of muscle breakdown. Raising a drug concentration is not the same as improving its benefit. Option d is incorrect because this interaction has nothing to do with speed of onset. Toxicity, not a quicker response, is what follows when metabolism through the liver enzyme system is suppressed.

Correct Answer: Atropine drawn up at the bedside

Edrophonium can provoke profound bradycardia and a surge of secretions if the client is already cholinergic. Atropine is the antidote, so it stays drawn up beside suction, oxygen and intubation equipment. Option a is incorrect because pyridostigmine is the maintenance drug, not the rescue drug for this test. Adding a longer acting anticholinesterase during the procedure would blur the result and could deepen a cholinergic reaction. Option b is incorrect because charcoal binds a drug swallowed by mouth. Edrophonium goes straight into a vein during this test, so nothing in the stomach could be adsorbed or removed. Option c is incorrect because cooling belongs to antimuscarinic poisoning, where sweating stops and the temperature climbs. A cholinergic reaction leaves the client damp with sweat instead, so overheating is not the threat.

Correct Answer: The sympathetic fight or flight division

Fight or flight responses come from sympathetic activation, where norepinephrine reaches adrenergic receptors. Beta one stimulation speeds the heart while reduced salivation dries the mouth, matching the pattern this client describes. Option b is incorrect because rest and digest activity works through acetylcholine at muscarinic receptors. That division slows the heart and increases salivation, producing the opposite of the pounding pulse and dryness reported here. Option c is incorrect because somatic motor nerves carry voluntary signals to skeletal muscle rather than to cardiac tissue or glands. Nothing in that pathway alters heart rate or saliva production during a frightening moment. Option d is incorrect because enteric neurons form a local network inside the bowel wall that governs peristalsis and secretion. Cardiac acceleration and dry mouth arise outside that circuitry, from adrenergic stimulation elsewhere.

Correct Answer: Myasthenic crisis from too little drug

Missed doses plus the stress of infection leave too little acetylcholine at damaged receptors. Ptosis, a weak cough and shallow breathing with normal pupils and no secretions point to myasthenic crisis. Option a is incorrect because drug excess announces itself with pinpoint pupils, drooling, sweating and twitching within an hour of a dose. This client took less drug, not more, and stayed dry. Option b is incorrect because hypersensitivity shows up as rash, itching, swelling or wheeze soon after exposure. Nothing here matches that pattern, and the weakness tracks the missed doses rather than any immune response. Option d is incorrect because muscarinic blockade brings flushed hot skin, wide pupils, a fast heart and delirium. A dry mouth alone is far too thin a basis for calling this antimuscarinic poisoning.

Correct Answer: The regimen is the likely cause

New confusion in an older adult is a drug effect until proven otherwise. Nine agents from three prescribers is polypharmacy, so the nurse compiles a full list and screens for interactions and inappropriate drugs. Option a is incorrect because ageing by itself does not produce disordered thinking. Accepting the change as normal delays the medication review that would uncover a sedating or anticholinergic agent behind the picture. Option c is incorrect because physical restraint increases injury, agitation, and immobility complications rather than preventing tumbles. Safety here comes from removing the offending drugs, not from binding a confused client to a chair. Option d is incorrect because a neurodegenerative diagnosis cannot be made from an abrupt change over days. Dementia advances gradually across months and years, while a drug related delirium arrives quickly and can reverse.

Correct Answer: Voiding a moderate amount of urine

Bethanechol stimulates muscarinic receptors on the detrusor muscle and relaxes the internal sphincter, so the bladder contracts and empties. Voiding after the dose is the outcome the nurse watches for. Option b is incorrect because rising pressure with a bounding pulse belongs to sympathetic stimulation. Cholinergic drugs lower blood pressure and slow the heart, so the nurse would watch for hypotension and syncope instead. Option c is incorrect because dry mouth is what an anticholinergic produces. Bethanechol does the opposite, increasing salivation along with tearing and sweating, so a moist mouth fits the drug far better. Option d is incorrect because pupil widening reflects muscarinic blockade or adrenergic stimulation. A direct acting cholinergic drug narrows the pupil instead, and miosis is one reason pilocarpine helps lower pressure inside the eye.

Correct Answer: An intravenous benzodiazepine for the agitation

Benzodiazepines calm the agitation of antimuscarinic poisoning, and quieting the muscles limits heat production and rhabdomyolysis. Sedation with active cooling and cardiac monitoring is the supportive care given before any antidote. Option a is incorrect because catheter placement relieves retention but leaves an agitated, overheating client thrashing on the stretcher. Bladder drainage matters later, once sedation, cooling and cardiac monitoring have stabilised him. Option b is incorrect because adding another muscarinic blocker pours fuel on the poisoning. Scopolamine and its relatives would deepen the delirium, drive the temperature higher and worsen the retention already present. Option d is incorrect because the fever here comes from absent sweating, not from a reset hypothalamic set point. Antipyretics fail against that mechanism, and an oral drug is unsafe in a delirious client.