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

Correct Answer: "I put the new patch on before removing the old one."

Leaving the old patch in place while adding a new one doubles the delivered dose and can cause overdose. Teach the client to remove and discard the used patch first every time. Option a is incorrect because rotating application sites protects the skin from irritation and breakdown, which is exactly what the nurse wants to hear. This statement reflects correct self care. Option b is incorrect because hand washing after contact keeps residual medication from being absorbed through the fingers. Nurses wear gloves for the same reason, so the client has learned the point well. Option c is incorrect because external heat speeds absorption and can drive too much drug into the blood. Avoiding a heating pad over the site shows the client already grasps that hazard.

Correct Answer: Atropine given by the intravenous route

Atropine blocks the muscarinic receptors that acetylcholine is flooding, so secretions dry, wheezing eases and the heart rate rises. Doses are repeated and titrated until the airway secretions stop. Option a is incorrect because bethanechol is a direct muscarinic agonist used to start a stalled bladder. Giving it now would add to the flood of cholinergic activity already drowning this worker. Option c is incorrect because pyridostigmine prevents the breakdown of acetylcholine, which is precisely the problem the insecticide created. It treats myasthenia gravis and would deepen every finding described here. Option d is incorrect because neostigmine reverses nondepolarizing neuromuscular blockade after surgery by raising synaptic acetylcholine. Pushing that drug into a poisoned client would worsen the bradycardia and fill his airway further.

Correct Answer: Give epinephrine into the anterolateral thigh

Epinephrine is the drug of choice for anaphylaxis because it constricts vessels through alpha one receptors while opening the airway through beta two receptors. Intramuscular thigh injection absorbs fastest. Option a is incorrect because an antihistamine only blocks histamine already released and works far too slowly for a closing airway. It is an adjunct given after the priority drug. Option b is incorrect because a nebulized bronchodilator opens airways but does nothing for the vasodilation and circulatory collapse driving this reaction. Wheeze is only part of the emergency. Option d is incorrect because steroids take hours to reduce inflammation and are used to blunt a later rebound phase. Relying on them first would leave the airway swelling untreated.

Correct Answer: The right documentation

Charting must follow administration, never precede it. Entering the dose beforehand records an event that has not happened, which is falsification and hides an omission if the infusion is interrupted or never hung. Option a is incorrect because the nurse did confirm who the client was, using two approved identifiers at the bedside. That element of the sequence was performed correctly and is not the flaw here. Option c is incorrect because an antibiotic ordered for infusion was hung as an infusion, matching both the prescribed path and the dosage form. Nothing in the description suggests a substituted delivery method. Option d is incorrect because indication concerns whether the client's history supports treatment with this drug. No detail here challenges the appropriateness of an antibiotic, so that right remains intact throughout the sequence.

Correct Answer: "I will never stop this drug on my own."

Abrupt withdrawal of a long term corticosteroid can precipitate adrenal insufficiency, so any change belongs to the prescriber. Recognising that the drug must be tapered rather than halted shows the teaching landed. Option a is incorrect because self adjusting upward is prescribing without authority and adds hyperglycemia, infection risk, and mood disturbance. Returning symptoms need a call to the prescriber rather than an extra tablet. Option b is incorrect because feeling better is the commonest reason clients abandon therapy early. With this drug class an abrupt halt strips the body of cortisol it has stopped making, which can end in collapse. Option c is incorrect because giving a prescribed product to another person bypasses assessment, allergy screening, and any indication. It also leaves the client short of doses and is unlawful in every jurisdiction.

Correct Answer: Competitive antagonism overcome by excess agonist

Naloxone competes reversibly for the same site, so a flood of opioid can outnumber it and push the blocker off. Repeat dosing restores the balance until the opioid itself is eliminated. Option b is incorrect because a noncompetitive blocker grips so tightly that added agonist changes nothing, and effect fades only as new receptors form. Aspirin on platelet enzyme behaves that way. Option c is incorrect because partial agonism describes a drug that switches the receptor on weakly, such as buprenorphine. The reversal agent here turns the receptor off rather than triggering any ceiling effect. Option d is incorrect because antacids and chelating agents work by chemical binding outside any receptor system. This opioid reversal depends entirely on occupying a specific protein site, so the mechanisms differ.

Correct Answer: Take each dose about thirty minutes before meals

Pyridostigmine blocks acetylcholinesterase so more acetylcholine reaches the remaining receptors. Dosing thirty to sixty minutes ahead of a meal puts peak muscle strength at the moment the client must chew and swallow. Option a is incorrect because taking the tablet afterwards leaves the client weakest during the meal itself. Bulbar weakness makes chewing and swallowing unsafe, and aspiration is the risk this schedule is designed to prevent. Option c is incorrect because one large morning dose would flood the synapse early and leave nothing for the evening, when weakness is usually worst. Divided doses keep the effect steady across the day. Option d is incorrect because waiting for symptoms turns a scheduled drug into a rescue drug. A missed or delayed dose lets acetylcholine fall far enough to trigger myasthenic crisis and respiratory failure.

Correct Answer: Lower digoxin levels and serotonin syndrome

St John's wort is a strong enzyme inducer, dropping levels of digoxin and oral contraceptives, and it also adds serotonin activity to an antidepressant. Breakthrough pregnancy, lost cardiac effect, and serotonin syndrome all follow. Option a is incorrect because induction drives cardiac glycoside levels down rather than up, so the client loses effect instead of gaining toxicity. Contraceptive failure is real, but the digoxin direction is reversed. Option b is incorrect because ginkgo, garlic, ginger, and fish oil are the supplements linked to bleeding. This herb raises serotonin tone alongside an antidepressant instead of blunting it. Option c is incorrect because a sudden dangerous rise in blood pressure comes from tyramine foods paired with a monoamine oxidase inhibitor. Nothing in this client's regimen sets up that particular emergency.

Correct Answer: Effective and toxic levels sit very close together

A narrow therapeutic index means the dose that works and the dose that harms are barely separated. Serum monitoring is the only reliable way to keep these agents inside a safe range. Option b is incorrect because every one of these agents has a published range reported by the laboratory, which is precisely why samples are collected. Warfarin, by contrast, is followed through a clotting test. Option c is incorrect because adherence checking is not the purpose behind scheduled peak and trough sampling. Levels guide dose adjustment, and a therapeutic result tells the team the current regimen is safe. Option d is incorrect because marrow suppression is a signature of chemotherapy and a few antimicrobials, not of these three. Their warning signs are visual halos, coarse tremor, and unsteady gait instead.

Correct Answer: Body weight in kilograms

Pediatric amounts are individualised by weight in kilograms, or by body surface area for some agents. The nurse weighs the child, uses that figure for every calculation, and checks it against a safe range. Option a is incorrect because stature alone tracks poorly with the volume a drug distributes into. Two children of identical length can differ markedly in mass, and the drug would be under or over delivered. Option b is incorrect because children of the same age vary enormously in size and organ maturity. Age helps choose the dosage form and the teaching approach, yet it cannot set the amount by itself. Option d is incorrect because skull measurement screens neurologic growth in infancy and has no bearing on drug distribution or clearance. Nothing about that number predicts how much medication a small body can handle.

Correct Answer: "My pupils will get smaller and dim rooms will look darker."

Pilocarpine stimulates the muscarinic receptors of the iris sphincter, so the pupil constricts and the trabecular meshwork opens for aqueous drainage. Miosis also means less light enters, making dim surroundings harder to see. Option b is incorrect because a widened pupil is what an antimuscarinic drop produces. Mydriasis crowds the drainage angle and raises pressure inside the eye, the opposite of what glaucoma therapy needs. Option c is incorrect because cholinergic stimulation increases tear flow rather than reducing it. Drier eyes come from blocking acetylcholine at the lacrimal gland, which is a hallmark of the anticholinergic group. Option d is incorrect because blurred vision and brow ache follow the drop for a while before settling. Sharper sight is not the promise of this drug, whose purpose is protecting the optic nerve.

Correct Answer: "I will stop the pill once my headaches go away."

High blood pressure is usually silent, so relief of a symptom is no signal to stop. Discontinuing the drug allows pressure to climb again and raises the risk of stroke and kidney damage. Option a is incorrect because continuing therapy despite feeling well is precisely the behaviour teaching aims to produce. Asymptomatic conditions still require daily treatment, and this remark shows the client grasped that point. Option b is incorrect because carrying a current list to each visit is a recognised adherence cue. It lets every prescriber see the whole regimen and prevents duplicate or interacting orders being written. Option d is incorrect because checking before adding a nonprescription product protects against interactions such as decongestants raising pressure. Seeking guidance first reflects understanding rather than a gap in learning.

Correct Answer: Detrusor contraction with sphincter relaxation

Rest and digest activity empties hollow organs, so acetylcholine at muscarinic receptors squeezes the detrusor while the internal sphincter relaxes. That pairing lets urine flow, the opposite of the sympathetic pattern that causes retention. Option a is incorrect because that combination is the sympathetic pattern, which stores urine rather than releasing it. Alpha one stimulation at the bladder neck is exactly what produces postoperative urinary retention. Option b is incorrect because a slack detrusor cannot generate the pressure needed to expel urine, whatever the sphincter does. Emptying requires active muscular contraction of the bladder wall itself. Option c is incorrect because a closed outlet blocks flow even while the bladder wall squeezes, raising pressure without voiding. Coordinated emptying demands that the sphincter open as the detrusor tightens.

Correct Answer: "I will rest in the shade and drink water often."

Anticholinergics shut down sweating, so the body loses its main way to shed heat. Staying in the shade, pacing activity and drinking fluids protect this client from hyperthermia and heat stroke. Option a is incorrect because the hottest part of the day is exactly when a client who cannot sweat is most likely to overheat. Early morning or evening walking would be far safer. Option c is incorrect because hot tubs, saunas and long hot baths add heat the body cannot dump. Teaching for this class specifically warns against soaking in hot water while sweating is blocked. Option d is incorrect because restricting fluid invites dehydration, constipation and a thicker, drier mouth. Urinary retention is a real worry with this drug, but the answer is monitoring output rather than drinking less.

Correct Answer: Phentolamine diluted in normal saline

Phentolamine is a nonselective alpha blocker, so infiltrating it reverses the intense alpha one vasoconstriction choking the tissue. Restoring local blood flow within about twelve hours prevents the necrosis that otherwise follows. Option b is incorrect because glucagon reverses beta blocker overdose by raising intracellular messenger levels in cardiac cells. Injecting it around an infiltration would do nothing to relax the clamped down arterioles. Option c is incorrect because atropine blocks muscarinic receptors and is used for symptomatic bradycardia rather than tissue injury. Blocking those receptors cannot relieve vasoconstriction created by alpha one stimulation in the arm. Option d is incorrect because epinephrine is itself a powerful vasoconstrictor at alpha one receptors. Adding it to an ischemic area would deepen the blanching and hasten the tissue death being prevented.

Correct Answer: Explore the reason and notify the prescriber

Refusal is the client's right, and the nurse's job is to learn why, document the reason objectively, tell the prescriber, and revise the plan. Muscle aching on a statin also needs evaluation. Option a is incorrect because recording the event without exploring it strands a clinically meaningful complaint. Aching thighs on this drug class may signal myopathy, and the prescriber cannot act on information never passed along. Option b is incorrect because citing the order as justification pressures a competent adult and ignores autonomy. Persuasion built on authority does not address the symptom that prompted the client to decline. Option c is incorrect because concealing a drug in food to obtain compliance is deceptive and violates the right to decline. Covert administration without consent exposes the nurse to disciplinary and legal consequences.

Correct Answer: Toxicity from a larger free drug fraction

Only unbound drug is active, and low albumin leaves fewer sites to hold this agent. The free fraction climbs even though the total serum level looks normal, so toxic effects appear at a usual dose. Option a is incorrect because losing binding sites releases drug rather than sequestering it, pushing activity upward. Fewer carriers on albumin means more circulating active molecules, not a weaker therapeutic response. Option b is incorrect because stomach emptying speed belongs to absorption and shapes how soon a dose acts. Albumin sits in plasma and governs distribution, so the two processes affect entirely separate steps. Option d is incorrect because liver disease does not speed up glomerular filtration, and this client has no evidence of enhanced elimination. Expect drug to linger longer, which worsens rather than relieves the danger.

Correct Answer: Swallowing exposed the drug to first pass metabolism

A tablet that reaches the stomach is absorbed into portal blood and largely inactivated by the liver before circulating. Held under the tongue, nitroglycerin enters venous blood directly and relieves pain within minutes. Option a is incorrect because stomach acid is not what removes this drug from circulation. Hepatic enzymes acting on portal blood do the damage, and an antacid would not rescue the swallowed dose. Option c is incorrect because a small sip of water cannot dilute a dose already inside the body. Potency is fixed by the tablet strength, so volume of fluid is irrelevant here. Option d is incorrect because sublingual tablets dissolve in oral mucosa and never depend on gastric contents. Food status matters for many oral drugs, yet it has no bearing on mucosal uptake.

Correct Answer: Cardiac contractility and stroke volume

Beta one receptors concentrate in the myocardium, so a selective agonist strengthens each contraction and increases the volume ejected per beat. That is the point of dobutamine in a failing pump. Option b is incorrect because bronchial widening depends on beta two receptors in the lungs, which a cardioselective agent largely spares. Dobutamine is chosen for its inotropic action, not for airway support. Option c is incorrect because pupil diameter answers to alpha one receptors on the iris dilator muscle. A drug aimed at cardiac receptors produces no meaningful ocular change worth monitoring in shock. Option d is incorrect because sympathetic activity slows the gut rather than speeding it, and bowel activity is no measure of pump function. Perfusion goals guide titration of this infusion instead.

Correct Answer: Easier air movement and less wheezing

Albuterol stimulates beta two receptors on bronchial smooth muscle, relaxing it within minutes. Improved air entry with quieter breath sounds and less wheeze shows the airway has opened as intended. Option a is incorrect because miosis and tearing belong to cholinergic stimulation, the opposite branch of the autonomic system. Sympathomimetic drugs widen the pupil instead and do not increase tear flow. Option c is incorrect because heavier secretions reflect parasympathetic glandular activity rather than beta two agonist therapy. A rescue bronchodilator dries rather than floods the airway while it relaxes bronchial muscle. Option d is incorrect because sympathomimetic drugs raise heart rate and pressure rather than lower them. Tachycardia and palpitations are common albuterol side effects, so a falling pulse would be unexpected here.