NR-293 Pharmacology for Nursing Practice - Set 5 - Part 3

Correct Answer: Shortly before the scheduled dose is hung

The trough is the lowest concentration in the dosing interval, so it is drawn within thirty minutes before the next dose. A trough above the target range warns that drug is accumulating. Option a is incorrect because a random midpoint sample matches neither the highest nor the lowest concentration, so the laboratory cannot compare it with a reference range. The result would guide no dosing decision. Option b is incorrect because thirty minutes after the infusion finishes is when the peak is collected, and the peak confirms the level is high enough to kill the organism. Option c is incorrect because blood drawn as the infusion begins reflects drug still entering the vein rather than a completed dosing interval. Such a sample overstates clearance and invites an unsafe dose increase.

Correct Answer: Aztreonam, a monobactam agent

The ring structure of aztreonam differs enough from other beta lactams that essentially no cross reactivity occurs with penicillin allergy. It covers aerobic gram negative organisms, which is exactly the coverage this client needs. Option a is incorrect because cephalosporins share the beta lactam ring and can trigger a reaction in penicillin allergic clients. With documented anaphylaxis in the record, this class is generally avoided rather than tried cautiously. Option c is incorrect because giving any penicillin to someone who has already had anaphylaxis to the class invites a repeat event. Allergy to one penicillin means allergy to all of them. Option d is incorrect because moving up a generation does not remove the shared ring that drives cross sensitivity. A fourth generation agent broadens coverage, yet the structural hazard for this particular client stays unchanged.

Correct Answer: The capillary blood glucose

The dextrose load in parenteral nutrition raises blood sugar quickly, especially under stress or steroids. Bedside glucose is checked every few hours at the start so insulin can be adjusted before hyperglycemia builds. Option a is incorrect because albumin turns over across about three weeks, so it reflects long standing nutritional status. Repeating it during a single day would show nothing, and prealbumin is the better short interval marker. Option b is incorrect because specific gravity gives a rough sense of hydration and nothing about the dextrose being infused. Intake, output and daily weight track fluid balance far more usefully during nutrition support. Option c is incorrect because triglycerides matter with lipid emulsions but are drawn periodically, not several times a shift. That value guides whether the fat component is cleared, a slower question than minute to minute sugar control.

Correct Answer: It shields the penicillin from bacterial enzymes

Clavulanate is an enzyme decoy, not an antibiotic. It sacrifices itself to beta lactamase so the amoxicillin molecule survives intact and can still block cell wall cross linking in producer strains. Option b is incorrect because clavulanate has no meaningful antibacterial activity of its own. Calling it a second antibiotic misreads the pairing, which works by protecting one drug rather than by attacking from two directions. Option c is incorrect because the intrinsic range of organisms amoxicillin can kill stays exactly the same. What changes is survival against strains that would otherwise cleave the beta lactam ring and destroy the drug. Option d is incorrect because the combination actually causes more diarrhea than amoxicillin alone, making it the worst choice for a gentle stomach. Comfort played no part in the prescriber's reasoning here.

Correct Answer: Drink generously and empty the bladder often

Acrolein, a cyclophosphamide metabolite, ulcerates the bladder wall while urine sits there. Generous fluids and frequent voiding, including during the night, dilute and flush the metabolite before it can burn the lining. Option a is incorrect because restricting fluids concentrates acrolein and holds it against the bladder wall through the night. That is precisely the pattern that produces hematuria and hemorrhagic cystitis. Option c is incorrect because clients do not decide when to skip a cytotoxic dose, and concentrated urine calls for more fluid rather than a missed treatment. Pink or tea colored urine is what gets reported. Option d is incorrect because a bedtime dose leaves the drug pooling in the bladder for hours of sleep. Morning dosing lets the client drink and void repeatedly while awake, which is the whole point.

Correct Answer: Store the tablets in a locked cabinet

Iron is a leading cause of poisoning death in young children, and the tablets resemble candy. Locking the container out of sight and reach removes the hazard that outranks every comfort measure here. Option a is incorrect because food does reduce nausea but also blunts absorption, and comfort never outranks a poisoning hazard sitting within a toddler's reach. Safety teaching comes first when a lethal ingestion is possible. Option b is incorrect because dark stools are an expected harmless change, worth mentioning but carrying no risk. Telling a parent about pigment while candy-like tablets sit on an open counter leaves the real danger unaddressed. Option d is incorrect because bowel management addresses the most common complaint, not the most dangerous one. Constipation is unpleasant and manageable at home, while an unsecured bottle of iron can kill a small child.

Correct Answer: Hold the dose and notify the provider

A trough above range with falling urine output means the drug is accumulating and the kidney is already being injured. Withholding the dose and notifying the provider stops further damage while it remains reversible. Option a is incorrect because giving more drug to a client who cannot clear what is already circulating deepens the tubular injury. Fluids help prevent nephrotoxicity but cannot rescue a kidney that is failing to excrete. Option c is incorrect because stretching the infusion time changes how fast the dose enters the blood, not how much total drug the client receives. The elevated trough would climb higher still. Option d is incorrect because audiology testing tracks hearing damage rather than the renal accumulation this trough reveals. Arranging a consultation is reasonable later, yet it leaves the unsafe dose sitting at the bedside.

Correct Answer: Stop the drug and contact the provider immediately

Rash with fever, blistering, and mucous membrane involvement points to Stevens Johnson syndrome, a dermatologic emergency carrying real mortality. The sulfonamide is stopped at once and the provider is notified. Option a is incorrect because soothing the skin while the offending drug continues is the classic wrong answer for this scenario. Epidermal detachment can progress over hours once mucous membranes are involved. Option b is incorrect because diphenhydramine treats histamine driven itching and does nothing for a severe cutaneous reaction of this type. Continuing the sulfonamide keeps feeding the process that is destroying skin. Option d is incorrect because this reaction is not dose dependent and a smaller amount still drives it. Nurses also cannot adjust a prescribed amount, and tapering only delays the step that actually helps.

Correct Answer: Hang dextrose ten percent at the same rate

Circulating insulin remains high after the dextrose stops, and rebound hypoglycemia follows. Hanging a ten percent dextrose solution at the same rate keeps the sugar supply going while the pharmacy sends the next bag. Option b is incorrect because closing the line removes every source of glucose from a client whose insulin level is still elevated. Drowsiness and sweating would deepen toward seizure while the nurse waits for a delivery. Option c is incorrect because saline supplies volume and sodium but not one calorie. The symptoms described come from falling blood sugar, and an isotonic salt solution cannot raise it at all. Option d is incorrect because watching a hypoglycemic client without intervening wastes the window for easy correction. Vital signs document the decline rather than reverse it, and a substitute infusion is available on the unit.

Correct Answer: "The bladder analgesic eased pain, but bacteria still remain."

Phenazopyridine numbs the bladder lining and relieves burning without killing anything, so symptom relief says nothing about the organism. The antibiotic course continues exactly as written until the capsules are gone. Option a is incorrect because the dye has no antibacterial action whatever; it is an analgesic that coats the bladder wall. Telling the client it cured the infection would send her home still infected. Option b is incorrect because stopping an antibacterial when symptoms ease leaves surviving organisms to regrow, often as a harder infection to treat. Only the analgesic is meant to be short lived. Option c is incorrect because antibacterial dosing follows a fixed schedule that keeps drug concentrations above the killing level. Taking capsules only when discomfort returns produces gaps that let resistant strains flourish.