NR-293 Pharmacology for Nursing Practice - Set 2 - Part 1

Correct Answer: Aching weak thighs with dark brown urine

Muscle pain and weakness together with dark urine point to rhabdomyolysis, where myoglobin released from breaking muscle can injure the kidneys. The statin is stopped and creatine kinase is measured quickly. Option a is incorrect because headache is a common and mild statin complaint that responds to simple analgesia. Nothing about it points toward muscle breakdown or the kidney injury that follows it. Option b is incorrect because loose stools reflect the gastrointestinal upset many clients notice early in therapy. This complaint warrants comfort advice and monitoring, not the urgent workup a myopathy demands. Option d is incorrect because indigestion after large meals is unrelated to skeletal muscle. Right upper quadrant pain with jaundice would raise liver concerns, but ordinary reflux does not signal either problem.

Correct Answer: Pulling water out of brain tissue

Mannitol is filtered and not reabsorbed, so it raises the osmolarity of blood and filtrate. Water follows that gradient out of swollen brain tissue and leaves the body as a large diuresis. Option b is incorrect because sodium transport in the thick ascending limb is the target of furosemide and its relatives. Loop agents are chosen for pulmonary congestion, not for pressure inside the skull. Option c is incorrect because acetazolamide is the agent that curbs fluid secretion, and it does so in the eye for glaucoma. Osmotic therapy moves water already present rather than slowing its formation. Option d is incorrect because narrowing cerebral vessels would cut perfusion to an injured brain and worsen ischemia. This drug has no direct action on vascular smooth muscle at all.

Correct Answer: Headache is expected and treated with acetaminophen

Cerebral vessels dilate along with coronary and peripheral vessels, so headache appears early and usually fades over the first week. A mild analgesic controls it while therapy continues at the ordered dose. Option a is incorrect because nitrate headache comes from vessel dilation, not from a rising pressure inside the skull. Raised intracranial pressure would bring vomiting, altered consciousness and pupil changes as well. Option b is incorrect because escalating the amount would intensify the very symptom the client dislikes and drop blood pressure further. Titration follows anginal control and tolerance, never the severity of a headache. Option d is incorrect because hypersensitivity would show urticaria, angioedema or bronchospasm rather than a predictable ache in the temples. Almost every client starting a nitrate experiences this vascular effect at first.

Correct Answer: Cardiac rhythm on the bedside monitor

Milrinone strengthens contraction while dilating vessels, and ventricular tachycardia is its characteristic conduction problem. Continuous rhythm monitoring catches that early, with blood pressure watched alongside because hypotension limits how much can be infused. Option b is incorrect because bowel activity is unaffected by this inodilator. Constipation belongs with verapamil, and listening to the abdomen would not detect the dysrhythmia this infusion is known to trigger. Option c is incorrect because turgor gives a rough picture of hydration and changes far too slowly to guide a titrated infusion. Urine output is the better volume measure here. Option d is incorrect because pupillary response tracks neurologic status, which this drug does not directly threaten. The danger sits in the ventricle, where ectopy can degrade into a lethal rhythm.

Correct Answer: Hold the dose and call the prescriber

Stacking a rate slowing calcium channel blocker on a beta blocker can produce severe bradycardia, block, and hypotension. With a pulse already below sixty and a low pressure, both doses wait until the prescriber decides. Option a is incorrect because rechecking afterward cannot undo a dose that has already been absorbed. Vital signs taken before the dose are what protect the client, and they are outside safe limits. Option b is incorrect because separating administration times does nothing about the combined depressant effect on the node. Both agents are still circulating together an hour later, and the pulse would fall further. Option d is incorrect because a beta blocker also slows the sinus node, so giving it alone leaves the same bradycardia problem. Hold parameters apply to that drug exactly as they do here.

Correct Answer: I will count my pulse for a full minute first.

Counting the radial pulse for a full minute before each dose is the safety habit that catches bradycardia early. The client also reports anorexia, nausea, halos, or confusion without waiting for the next visit. Option a is incorrect because doubling up pushes the concentration of a narrow range drug toward the toxic zone. A missed dose is simply skipped, and the client takes the next one on schedule. Option b is incorrect because the glycoside does not waste potassium, so adding a supplement on impulse can swing the level in either direction. Changes to potassium intake belong to the prescriber. Option c is incorrect because feeling better means the therapy is working and should continue. Stopping a heart failure drug once symptoms ease invites the congestion and hospital readmission it was preventing.

Correct Answer: Early in the morning after breakfast

Morning dosing lets the diuresis finish during waking hours. A tablet taken later drives the client out of bed repeatedly, and that broken sleep is a leading reason people abandon diuretic therapy. Option b is incorrect because bedtime dosing produces nocturia, repeated trips to the bathroom in the dark, and a real fall risk. Sleep loss follows, and clients who lose sleep often stop taking the drug. Option c is incorrect because an evening dose peaks while the client is lying down, so urine output interrupts rest. Diuretics belong in the daytime, and no benefit offsets the disrupted night that follows. Option d is incorrect because symptom driven dosing leaves the schedule irregular and blood pressure control uneven. A thiazide works as a steady daily agent rather than as a rescue drug taken when swelling appears.

Correct Answer: "I will call for an ambulance if three tablets fail"

One tablet goes under the tongue every five minutes for a maximum of three doses. Pain that survives that sequence, or worsens after the first tablet, means emergency services must be summoned. Option a is incorrect because hourly spacing wastes the window in which reperfusion still saves myocardium. The prescribed interval between sublingual doses is five minutes, not sixty, and delay allows infarction to proceed. Option b is incorrect because a client having ongoing chest pain can lose consciousness or arrest at the wheel. Driving also delays the monitoring and drug therapy that an ambulance crew begins immediately. Option c is incorrect because stacking the full supply at one time produces severe hypotension and reflex tachycardia. Doses are separated deliberately so blood pressure can be judged before the next tablet.

Correct Answer: It digests the fibrin mesh of an existing clot

Alteplase converts plasminogen trapped inside the clot into plasmin, which chews through fibrin and reopens the vessel. No other coagulation modifier can remove a thrombus that has already formed. Option a is incorrect because interference with platelet aggregation describes aspirin and clopidogrel. Those drugs stop a new plug from building on injured arterial wall, leaving established fibrin clots completely intact. Option b is incorrect because suppressing factor synthesis in the liver is warfarin's mechanism. That approach slows further clotting over days and offers nothing for brain tissue dying within the next hour. Option d is incorrect because lowering blood viscosity belongs to pentoxifylline, a hemorheologic given for intermittent claudication. Thinner blood flows more easily through narrowed vessels but never dissolves a formed thrombus.

Correct Answer: The client taking a daily loop diuretic

Loop diuretics dump potassium in the urine, and a falling potassium level makes digoxin bind more tightly to the cardiac pump. That pairing is the most common route to toxicity on a medical unit. Option b is incorrect because fruit high in potassium tends to protect against the deficit that drives toxicity. Ordinary dietary intake does not push the serum drug concentration upward. Option c is incorrect because using a walker signals a mobility problem and a fall risk rather than an altered drug level. Nothing about assistive devices changes how the kidney clears this medication. Option d is incorrect because a softener works in the bowel and has no effect on serum potassium. Bran and antacids can slow absorption, but the risk being asked about here is toxicity.

Correct Answer: Diltiazem taken in divided daily doses

Diltiazem and verapamil block calcium in the sinus and atrioventricular nodes as well as in vessels, so they slow conduction and lower pressure. The dipine agents act on arterioles and leave rate untouched. Option a is incorrect because this vascular selective agent lowers pressure smoothly but has no effect at the atrioventricular node. The ventricular rate would stay rapid despite good pressure control. Option b is incorrect because arteriolar dilation from this drug can trigger a reflex rise in heart rate. Adding it to an already fast rhythm works against the goal the provider described. Option c is incorrect because the dipine ending marks a vessel selective drug, useful for pressure and for coronary spasm. Rhythm control is simply outside what this subgroup does.

Correct Answer: Widened veins that reduce preload and oxygen demand

Nitrates convert to nitric oxide in vascular smooth muscle, and at usual doses the venous bed relaxes most. Blood pools peripherally, filling volume falls, and the ischemic myocardium needs less oxygen. Option b is incorrect because positive inotropic action belongs to digoxin and dobutamine, which strengthen contraction and raise oxygen consumption. A stronger squeeze would worsen ischemic chest pain rather than abolish it within minutes. Option c is incorrect because beta blockade describes metoprolol and atenolol, agents taken daily to prevent attacks. Those drugs work too slowly to abort an episode, and they do not dilate the venous circulation. Option d is incorrect because accelerated nodal conduction raises heart rate, which shortens diastole and cuts coronary filling time. Nitroglycerin does the opposite for the myocardium by easing the volume returning to the ventricle.

Correct Answer: Ototoxicity that rises with rapid infusion

Loop diuretics damage the cochlea, and the risk climbs sharply when the drug enters the bloodstream fast. Standard doses go in over one to two minutes, and tinnitus signals that the infusion must stop. Option a is incorrect because sulfa reactions show up as rash, fever, or anaphylaxis rather than hearing changes. Furosemide does carry a sulfonamide structure, yet allergy is not what injures the cochlea here. Option b is incorrect because a falling potassium produces weakness, cramps, and flattened T waves on the tracing. Nerve conduction in the ear is not the pathway involved, and the complaint arrived far too quickly for depletion. Option d is incorrect because cerebral hypoperfusion causes lightheadedness, blurred vision, and syncope instead of a steady ringing. Blood pressure certainly falls with this drug, though that drop does not create tinnitus.

Correct Answer: Stopping all heparin and starting argatroban

Antibodies against heparin and platelet factor four activate the remaining platelets, so the client clots despite a low count. Every heparin source stops, and a non heparin anticoagulant such as argatroban replaces it. Option a is incorrect because any continued exposure keeps the immune reaction alive, and flushes or coated catheters count as exposure. Lowering the rate leaves the client hypercoagulable and at risk for limb loss. Option c is incorrect because starting a vitamin K antagonist first depletes proteins C and S, deepening the clotting tendency and risking venous limb gangrene. Warfarin waits until the platelet count recovers. Option d is incorrect because transfused platelets feed the same antibody driven activation and can worsen thrombosis. The problem is immune destruction with paradoxical clotting, not a simple shortage that replacement would fix.

Correct Answer: I should leave grapefruit juice out of my breakfast.

Grapefruit blocks the intestinal enzyme that breaks this drug down, so blood levels climb and hypotension can follow. Leaving the juice out of the diet keeps the dose predictable from day to day. Option b is incorrect because salt substitutes are mostly potassium chloride, a caution that belongs with drugs that retain potassium. This client's drug does not raise the potassium level at all. Option c is incorrect because an extended release tablet must go down whole. Chewing releases the entire dose at once and can drop pressure sharply, whatever beverage happens to accompany it. Option d is incorrect because ankle swelling with this class comes from pressure inside the capillaries, not from too little fluid. Drinking more will add to the puffiness instead of relieving it.

Correct Answer: Nitroglycerin, a sublingual nitrate tablet

Only the rapid acting sublingual nitrate works fast enough to relieve pain already present. The other three lower the frequency of episodes over time and have no role during an attack. Option a is incorrect because a dihydropyridine taken once daily builds steady arterial dilation for prevention. Its onset is far too slow to help a client whose pain began minutes ago. Option b is incorrect because beta blockade reduces how often ischemia occurs by trimming rate and contractility. Swallowing one during an episode will not open vessels or shorten the painful period. Option d is incorrect because this agent alters sodium handling inside the myocyte for chronic symptom control. Labelling states plainly that it does not treat an anginal episode in progress.

Correct Answer: Stop the infusion and notify the provider

Perioral numbness, drowsiness and slurred speech are the early neurological warnings of lidocaine toxicity, which progresses to seizures and arrest. Stopping the infusion and calling the provider halts that progression. Option a is incorrect because more drug drives the client toward twitching, convulsions and respiratory failure. Rate increases are considered only when ectopy persists and the neurological examination stays entirely clear. Option c is incorrect because an hour of observation allows serum concentrations to climb further while the client deteriorates. These findings are not a passing complaint that can safely be watched. Option d is incorrect because supplemental oxygen treats hypoxia rather than a drug level rising in the blood. Leaving the rate unchanged permits the very toxicity the nurse has already recognised.

Correct Answer: Withhold the digoxin and report the potassium

Low potassium lets more digoxin bind the pump, so toxicity can occur even at an ordinary serum level. Fatigue and nausea already suggest it, making withholding the dose and reporting the value the safest first move. Option a is incorrect because dietary sources raise potassium far too slowly to protect this client today. Food may be part of the longer plan, yet it does nothing about the dose due within the hour. Option b is incorrect because administering the glycoside into a potassium deficit is the exact combination that produces dysrhythmia. Charting the symptom without acting on it leaves the danger fully in place. Option c is incorrect because waiting until another tablet has been swallowed allows the level to climb higher. Assessment matters, but it belongs before the drug is given rather than after.

Correct Answer: Hold the dose and notify the prescriber

An adult apical pulse below sixty is the standard hold parameter for digoxin, since the drug already slows the rate and bradycardia can also be the first sign of toxicity. Notifying the prescriber follows. Option a is incorrect because giving a rate slowing drug to a client who is already bradycardic can drop the pulse further and produce heart block. Rechecking afterward does nothing to prevent that harm. Option c is incorrect because delay wastes time without changing the decision, and a radial count is less reliable than an apical count in a client whose beats may not all perfuse. Option d is incorrect because fluid with the tablet addresses swallowing comfort, not safety. The pulse is the parameter that decides whether this dose is given, and it sits below the accepted limit.

Correct Answer: Sit down before placing the tablet

Nitroglycerin drops blood pressure quickly and often brings dizziness, so a client who stays upright may faint and fall. Sitting or lying down first protects the client during the dose. Option a is incorrect because exertion keeps myocardial oxygen demand high, which is what provoked the ischemia in the first place. Movement also raises the chance of syncope once the drug dilates vessels. Option b is incorrect because remaining on the feet leaves the client vulnerable to a fall when pressure drops. Breathing techniques do nothing for coronary blood flow during an ischemic episode. Option d is incorrect because fluid in the mouth washes the tablet toward the stomach and defeats absorption under the tongue. Hydration is not the safeguard needed at the moment of dosing.