NR-293 Pharmacology for Nursing Practice - Set 3 - Part 1

Correct Answer: Rebound swelling from prolonged spray use

Topical decongestants used beyond about three days produce rhinitis medicamentosa. As each dose wears off the nasal vessels dilate wider than before, so the client sprays again and the cycle tightens. Option a is incorrect because sinus infection usually brings facial pain, fever, and colored drainage rather than congestion that eases briefly with every spray. The timing here points squarely at the medication. Option b is incorrect because the drug still constricts vessels perfectly well, which is why brief relief follows each dose. The problem lies in the rebound dilation that follows, not in a weakened bottle. Option d is incorrect because a preservative reaction would bring itching, sneezing, and burning soon after the first few uses. This client felt genuine relief for days before the congestion returned harder.

Correct Answer: Do not take the dose without the meal

A sulfonylurea drives insulin release whether food arrives or not, so taking it without eating sets up hypoglycemia. The dose is held when the meal is skipped, and the provider is told about the new schedule. Option b is incorrect because swallowing a secretagogue with nothing to absorb is the classic route to a serious low. Older adults especially may have prolonged episodes needing extended observation. Option c is incorrect because doubling compounds the same hazard rather than solving it, and no client adjusts an oral agent independently. Larger amounts of released insulin mean deeper and longer lows. Option d is incorrect because glipizide is timed about thirty minutes before breakfast so its effect matches food intake. A bedtime dose would act overnight while the client is fasting and asleep.

Correct Answer: "I use fluticasone first when wheezing starts suddenly."

Fluticasone damps inflammation over days and cannot open a closing airway. Grabbing it during an attack wastes the minutes that albuterol would use to relax smooth muscle, so this statement needs correction. Option a is incorrect because twice daily dosing of an inhaled corticosteroid is exactly right. Controllers work only when taken on schedule, and this client has described the intended maintenance pattern. Option b is incorrect because carrying the rescue inhaler everywhere is precisely what nurses teach. Sudden bronchospasm gives no warning, so albuterol must travel with the client instead of sitting at home. Option d is incorrect because rinsing after a steroid inhalation prevents oral thrush and hoarseness. That habit shows sound understanding and gives the nurse nothing to correct during this encounter.

Correct Answer: "I reach for the salmeterol when wheezing starts."

Salmeterol has a slow onset and cannot reverse an attack in progress. Waiting for it while the airway narrows is dangerous, so albuterol remains the drug reached for at the first wheeze. Option b is incorrect because spacing salmeterol doses roughly half a day apart matches the twelve hour duration. Even spacing keeps the airway supported around the clock and reflects correct understanding. Option c is incorrect because a rescue inhaler kept within reach is standard advice for anyone with asthma. Bronchospasm can start anywhere, and this client has already built the habit nurses want. Option d is incorrect because continuing the inhaled corticosteroid is mandatory alongside any long acting beta agonist in asthma. Dropping the steroid would raise the risk of a fatal attack rather than lower it.

Correct Answer: Separate the supplements from levothyroxine by four hours

Calcium and iron bind levothyroxine in the gut and form complexes that never reach the bloodstream. A gap of at least four hours protects the dose and keeps the thyroid stimulating hormone result reliable. Option a is incorrect because simultaneous dosing puts the binding minerals and the hormone in the same place at the same moment, which is exactly the situation that wastes much of the prescribed thyroid replacement. Option b is incorrect because sixty minutes leaves the hormone still moving through the small intestine, where the minerals catch it. The recommended interval runs four times that long for a reason. Option d is incorrect because crushing changes nothing about the chemical attraction between the mineral and the hormone. Mixing everything into food adds fiber and soy proteins that further reduce how much levothyroxine gets absorbed.

Correct Answer: Calf pain with swelling or sudden chest pain

Estrogen raises clotting risk, and the boxed warnings cover cardiovascular events and stroke. Pain and swelling in one leg or sudden chest pain with breathlessness suggest a clot, so the client seeks care immediately. Option a is incorrect because sore breasts and queasy mornings are frequent nuisance effects that usually fade over the first months. They warrant mention at the next visit rather than an urgent telephone call. Option b is incorrect because cooler nights and better rest are the results the therapy was prescribed to achieve. Reporting improvement as an emergency would confuse the client about which changes actually signal danger. Option c is incorrect because fluid retention with a small weight change reflects the sodium holding action of estrogen. Limiting salt handles it, and nothing about mild puffiness suggests a vessel has been blocked.

Correct Answer: Lower urine output with higher specific gravity

Desmopressin replaces antidiuretic hormone, so the kidney reabsorbs water again. Urine volume falls, the urine grows concentrated with a higher specific gravity and osmolality, thirst eases, and a high serum sodium drifts back toward normal. Option b is incorrect because that combination describes untreated diabetes insipidus itself. Seeing it after a dose means the hormone is not reaching the kidney, perhaps from nasal congestion or faulty administration technique. Option c is incorrect because an unchanged pattern means nothing has improved. Effective therapy visibly cuts the volume the client passes, and a sodium that never moves suggests the dose is too small. Option d is incorrect because potassium is not the electrolyte this drug moves. Water retention dilutes the blood and pushes sodium downward, which is why hyponatremia rather than a potassium rise is the concern.

Correct Answer: Take a folic acid supplement as prescribed

Sulfasalazine interferes with folate absorption, so a supplement is standard while therapy continues. The nurse also warns that the drug carries a sulfa moiety and tints urine and skin a harmless yellow orange. Option a is incorrect because the yellow orange tint is a harmless, expected change in urine and skin. Warning clients ahead of time prevents an unnecessary phone call and keeps therapy from being abandoned. Option b is incorrect because generous fluid intake is encouraged with this drug to protect the kidneys from crystal formation. Restricting fluids in a client already losing stool volume invites dehydration. Option c is incorrect because aminosalicylates are first line maintenance therapy for mild to moderate disease, taken steadily rather than episodically. Reserving the drug for flares leaves the colon inflamed between episodes.

Correct Answer: An insulin syringe and an independent double check

Insulin is high alert, so only an insulin syringe or pen is used and a second licensed nurse verifies the dose independently. The word units is written out rather than abbreviated. Option a is incorrect because a tuberculin syringe is calibrated in millilitres and cannot measure units accurately. Skipping verification also removes the safeguard that catches tenfold errors before they reach the client. Option b is incorrect because the pen itself is acceptable, yet shortening the word units to a single letter is banned. That letter is easily read as a zero, multiplying the dose. Option d is incorrect because ordinary syringes lack unit markings, and a verbal order for a high alert drug bypasses written verification. Both shortcuts have produced fatal overdoses in reported cases.

Correct Answer: Rinsing with water and spitting it out

Rinsing washes steroid off the oral mucosa, and spitting keeps it from being swallowed. Drug left sitting on the mucosa suppresses local defenses and lets Candida overgrow into visible white patches. Option b is incorrect because swallowing the rinse sends the drug to the stomach, where a portion is absorbed. The mouth may be cleared, yet the point of spitting is avoiding that swallowed load. Option c is incorrect because brushing beforehand does nothing about drug deposited during the dose that follows. Oral hygiene helps overall, but the thrush risk comes from residue left behind after inhaling. Option d is incorrect because sugar free gum eases dry mouth from anticholinergic inhalers rather than preventing fungal overgrowth. Comfort measures do not remove corticosteroid particles clinging to the tongue and throat.

Correct Answer: An antihistamine such as dimenhydrinate

Motion sickness starts in the vestibular apparatus, where histamine and acetylcholine carry the signal. Antihistamines and anticholinergic patches interrupt it, and a dose taken thirty to sixty minutes before travel prevents the nausea. Option a is incorrect because serotonin blockers act at the chemoreceptor trigger zone and vagal terminals, which suits chemotherapy, radiation, and surgery. Inner ear signalling runs through a pathway this class does not reach. Option b is incorrect because aprepitant blocks substance P for delayed nausea after chemotherapy and is combined with other agents in that setting. Nobody prescribes it for a weekend on the water. Option d is incorrect because dronabinol works in the cerebral cortex and is reserved for chemotherapy nausea that resisted everything else. Its anxiety, confusion, and euphoria make it a poor travel remedy.

Correct Answer: Sore throat with fever and chills

Both thionamides can wipe out granulocytes without warning, and infection is what kills. A sore throat with fever signals possible agranulocytosis, so the drug stops and a complete blood count with differential follows immediately. Option a is incorrect because queasiness ranks among the ordinary complaints of this class and usually settles as therapy continues. Taking the tablet with food generally handles it without any interruption of treatment. Option c is incorrect because pounds returning as the overactive gland slows down is the expected therapeutic response. Gaining weight tells the nurse the hormone output is falling, which is exactly the goal here. Option d is incorrect because rash and pruritus are common minor reactions handled with an antihistamine while dosing continues. Skin irritation alone carries none of the urgency attached to a failing bone marrow.

Correct Answer: Roll the vial between the palms

Cloudiness is normal for NPH because it is a suspension. Gentle rolling between the palms redistributes the particles evenly, while vigorous handling creates bubbles that lead to inaccurate doses. Option b is incorrect because brisk agitation froths the suspension and traps air along the vial wall. Bubbles displace insulin in the syringe, so the measured amount understates the ordered dose. Option c is incorrect because a milky appearance signals an intact intermediate acting product, not contamination. Discarding usable insulin wastes a supply the client depends on and delays the scheduled dose. Option d is incorrect because heating alters the protein and can ruin potency. Letting a refrigerated vial reach room temperature on its own is enough to prevent the sting of cold insulin.

Correct Answer: Tachycardia with poor skin turgor

Watery stools carry off water and electrolytes fast, so the circulating volume drops. The heart speeds up to compensate and the skin loses elasticity, which is why pulse and turgor are watched closely. Option a is incorrect because volume loss lowers blood pressure and produces a weak, thready pulse. A bounding pulse with high pressure belongs to fluid overload, the opposite of this client's state. Option b is incorrect because potassium is lost in stool, so the level typically falls rather than rises. Hypokalemia brings weakness, cramping, and dysrhythmias, which is why the electrolyte panel is repeated. Option c is incorrect because moist membranes and springy skin describe adequate hydration, which contradicts the flat neck veins already documented. Those findings would suggest the diarrhea has not yet depleted the client.

Correct Answer: Withhold the next dose and notify the provider

Acute dystonia is an extrapyramidal reaction to dopamine blockade, and it can involve the airway if the spasm spreads. The nurse stops further dosing and gets an order for diphenhydramine or benztropine. Option b is incorrect because breathing exercises and repositioning treat anxiety, and this rigidity is pharmacologic rather than emotional. Comfort measures alone let the reaction continue while more drug remains scheduled. Option c is incorrect because heat relaxes a strained muscle, not a dystonic one driven by blocked dopamine receptors. The spasm keeps returning until the offending drug stops and an anticholinergic agent is given. Option d is incorrect because waiting an hour with a reaction that can tighten laryngeal muscles gambles with the airway. Documentation matters, yet it never substitutes for stopping the drug and calling the provider.

Correct Answer: It is taken nightly to prevent attacks

Montelukast blocks leukotriene receptors before inflammation builds, so it works only when taken on a fixed schedule. The evening dose prevents symptoms and does nothing for an attack already underway. Option a is incorrect because an oral tablet must be absorbed and distributed before any effect appears. Albuterol delivered straight to the airway opens it within minutes, which no swallowed drug can match. Option b is incorrect because leukotriene modifiers add to inhaled steroid therapy rather than standing in for it. Stopping the controller inhaler on this reasoning would leave airway inflammation poorly treated. Option c is incorrect because as needed use defeats a drug whose benefit depends on steady blockade. Taking it only when symptoms flare leaves the child unprotected on every other day.

Correct Answer: Withhold the drug and report the findings

Fever with watery stools after antibiotics in a client on acid suppression points toward Clostridioides difficile. Slowing transit traps the toxin and can trigger toxic megacolon, so the drug is held and reported. Option a is incorrect because giving an opiate agent in suspected infectious diarrhea prolongs contact between toxin and mucosa. Documenting the response afterward cannot reverse a colon that has already dilated. Option b is incorrect because flora restoring products help after antibiotic associated diarrhea, yet they do not make a contraindicated antimotility drug acceptable. The fever still demands stool testing and provider notification. Option d is incorrect because a comfort measure ignores a finding that signals a transmissible infection needing contact precautions and soap and water handwashing. Cramping relief is not the issue here.

Correct Answer: Take the antacid two hours after digoxin

Antacids bind other drugs and shift gastric pH, so digoxin absorption becomes unpredictable when the doses coincide. Giving the antacid at least two hours after digoxin keeps the narrow therapeutic level steady. Option a is incorrect because simultaneous dosing is exactly the situation that causes adsorption and chelation, pulling digoxin out of solution. The client could end up with subtherapeutic levels and returning heart failure symptoms. Option c is incorrect because heartburn treatment never justifies skipping a cardiac glycoside, and no prescriber authorized that change. Separating administration times solves the interaction while both drugs continue on their usual schedule. Option d is incorrect because chewing the antacid alongside digoxin still places both drugs in the stomach at once. Thorough chewing helps the antacid dissolve, yet it does nothing to prevent the absorption problem.

Correct Answer: The serum theophylline level has risen

Cigarette smoke induces the enzymes that clear theophylline, so quitting removes that push and the serum level climbs. Palpitations, insomnia, and tremor fit early toxicity, and the dose usually needs lowering. Option a is incorrect because withdrawal brings craving, irritability, and appetite change rather than this stimulant picture. Blaming nicotine would delay the serum measurement that this presentation clearly calls for. Option b is incorrect because a subtherapeutic level shows itself as returning wheeze and shortness of breath. Nothing in this report suggests loss of bronchodilation; the findings all point toward excess drug. Option c is incorrect because less caffeine would soften tremor and insomnia instead of producing them. Reduced stimulant intake cannot explain symptoms that appeared only after the cigarettes stopped.

Correct Answer: Drinking plenty of water through the day

Guaifenesin thins mucus by pulling water into it, so hydration does much of the work. A client who stays dry gets little benefit and keeps struggling to raise the same sticky secretions. Option a is incorrect because holding back fluids leaves secretions thick and harder to move upward. Restriction belongs to conditions such as fluid overload, not to a client trying to clear mucus. Option c is incorrect because extra doses do not loosen mucus faster and raise the chance of nausea and dizziness. An expectorant follows a set schedule rather than serving as a rescue remedy. Option d is incorrect because extended release tablets are swallowed whole to keep the drug releasing slowly. Crushing dumps the full amount at once and shortens the stretch of symptom relief.