NCLEX Practice Exam for Pharmacology 3

EXPLANATION

✔Correct answer:

Amitriptyline (Elavil), 10 mg four times daily. Amitriptyline is a tricyclic antidepressant primarily used to treat depression and certain types of chronic pain. It is not typically used to manage seizure disorders and can actually lower the seizure threshold, increasing the risk of seizures. Therefore, prescribing amitriptyline to a patient with a seizure disorder is not appropriate and could exacerbate the condition. Nurse Karen should question this prescription due to its potential to negatively affect Mr. Thompson's seizure control.

Tricyclic antidepressants, including amitriptyline, affect neurotransmitter levels in the brain, such as serotonin and norepinephrine. While these medications can be effective for depression and chronic pain, they also influence the central nervous system in ways that can provoke seizures, particularly in individuals with a pre-existing seizure disorder.

Giving amitriptyline to someone with a seizure disorder is like adding fuel to a fire. While it might help with certain issues (like pain or depression), it can also worsen the underlying problem (seizures) that you're trying to manage.

Nurse Karen should communicate her concerns to the prescribing physician and suggest alternative medications that do not increase seizure risk. She should also closely monitor Mr. Thompson for any signs of increased seizure activity or adverse effects from his current medications.

• Assess and document the patient's seizure activity and medication history.
• Consult with the healthcare provider about the appropriateness of each prescribed medication, particularly those known to affect the seizure threshold.
• Educate the patient and family about potential side effects and the importance of reporting any changes in seizure frequency or intensity.

✘Incorrect answer options:

Phenytoin (Dilantin), 100 mg three times daily. Phenytoin is a common anticonvulsant medication used to control seizures. This dosage is typical and appropriate for seizure management.

Phenobarbital, 150 mg at bedtime. Phenobarbital is another anticonvulsant that is often prescribed for seizure control. The dosage and timing are appropriate for managing seizures.

Valproic acid (Depakote), 150 mg twice daily. Valproic acid is also an anticonvulsant used to treat seizure disorders. The prescribed dosage is within the typical range for seizure management.

EXPLANATION

✔Correct answer:

In the lower conjunctival sac. Erythromycin ointment is administered to a newborn's eyes to prevent ophthalmia neonatorum, a form of conjunctivitis often caused by Neisseria gonorrhoeae or Chlamydia trachomatis. The correct site for applying the ointment is the lower conjunctival sac, which is the space between the inside of the lower eyelid and the eye itself. This area allows the medication to spread evenly over the eye's surface, providing optimal protection and minimizing discomfort to the newborn.

The conjunctival sac is the appropriate area because it ensures that the ointment comes into contact with the entire surface of the eye, including the conjunctiva and cornea, which are potential sites for infection. Applying the ointment in this manner helps prevent infection without causing damage or excessive irritation.

Think of applying sunscreen. You wouldn't just put it on a small spot; you spread it evenly across your skin to ensure full protection. Similarly, the lower conjunctival sac allows the ointment to be distributed effectively across the eye's surface.

Nurses should ensure that the newborn is calm and stable before applying the ointment. Using a gloved finger, they should gently pull down the lower eyelid to expose the conjunctival sac, then apply a thin ribbon of ointment from the inner to the outer corner of the eye. After application, they should gently close the baby's eye to help spread the ointment evenly.

• Wash hands thoroughly and wear gloves before the procedure.
• Hold the newborn securely but gently to prevent movement during application.
• Pull down the lower eyelid to expose the conjunctival sac.
• Apply a 1 cm ribbon of ointment along the inner aspect of the lower conjunctival sac.
• Gently close the newborn’s eye and massage the eyelid lightly to spread the ointment.
• Observe for any signs of adverse reactions, such as redness or swelling.

✘Incorrect answer options:

Near the optic disc. The optic disc is located at the back of the eye, where the optic nerve connects to the retina. It is not accessible or visible without special equipment and is not a site for medication application.

Directly on the cornea. Applying ointment directly on the cornea can cause irritation and potential damage to this sensitive part of the eye. The ointment should be placed in the lower conjunctival sac to avoid such risks.

Beneath the eyelid. While this might seem logical, it is less specific than placing the ointment in the lower conjunctival sac, which is the recommended practice to ensure even distribution and effectiveness of the medication.

EXPLANATION

✔Correct answer:

Roquefort, cheddar, or Camembert cheese. Patients taking MAO inhibitors, such as Nardil (phenelzine), must avoid foods high in tyramine to prevent hypertensive crises. Tyramine is an amino acid that helps regulate blood pressure, but when its levels become too high, it can cause a dangerous increase in blood pressure. MAO inhibitors block the enzyme monoamine oxidase, which normally breaks down excess tyramine in the body. Therefore, consuming high-tyramine foods can lead to severe hypertension in patients on MAO inhibitors.

The interaction between tyramine and MAO inhibitors leads to excessive accumulation of tyramine in the body, resulting in the release of large amounts of norepinephrine, a neurotransmitter that increases blood pressure. This can cause a hypertensive crisis, which is a sudden and severe increase in blood pressure that can be life-threatening if not managed promptly.

Think of the enzyme monoamine oxidase as a security guard that regulates the number of people (tyramine) entering a party (the body). MAO inhibitors disable the guard, leading to too many people entering the party, which can cause chaos (hypertensive crisis).

Nurse Megan should provide Mr. Brown with a comprehensive list of high-tyramine foods to avoid and educate him on the potential consequences of consuming these foods while on Nardil. Additionally, she should instruct him on what to do if he experiences symptoms of a hypertensive crisis, such as severe headache, chest pain, rapid heartbeat, or nausea.

• Educate Mr. Brown on the importance of reading food labels and being cautious about food preparation when eating out.
• Encourage Mr. Brown to maintain regular follow-up appointments to monitor his blood pressure and overall response to the medication.
• Provide written materials or resources that list high-tyramine foods and offer alternative dietary options.

✘Incorrect answer options:

Onions, garlic, or scallions. These foods are not high in tyramine and do not pose a risk for patients taking MAO inhibitors.

Ground beef, turkey, or pork. Fresh meats generally do not contain high levels of tyramine. However, aged, fermented, or improperly stored meats might, so it’s good to advise caution with certain types of meats.

Grape juice, orange juice, or raisins. These foods and beverages are not significant sources of tyramine and are typically safe for patients on MAO inhibitors.

EXPLANATION

✔Correct answer:

Pears canned in water. Triamterene (Dyrenium) is a potassium-sparing diuretic often used to treat edema and hypertension. This medication helps the body retain potassium while eliminating sodium and water. Because triamterene can lead to hyperkalemia (high potassium levels), it's important for clients to avoid high-potassium foods.

Hyperkalemia can lead to serious complications such as cardiac arrhythmias, muscle weakness, and even cardiac arrest. Therefore, dietary counseling for clients taking potassium-sparing diuretics should emphasize limiting potassium intake to prevent these risks.

Think of potassium in the body like a level in a swimming pool. Taking triamterene is like adding water to the pool. If you keep adding high-potassium foods, it’s like adding more water to an already full pool, causing it to overflow. Choosing low-potassium foods helps keep the water level safe and manageable.

Nurse Patel should educate the client on avoiding high-potassium foods and suggest alternatives that are low in potassium. Pears canned in water are low in potassium and are a safe choice for clients taking triamterene.

• Provide a list of high-potassium foods to avoid, such as oranges, bananas, and potatoes.
• Suggest low-potassium food options, such as apples, berries, and pears canned in water.
• Encourage the client to read food labels and be mindful of potassium content in processed foods.
• Recommend regular monitoring of potassium levels as prescribed by their healthcare provider.

✘Incorrect answer options:

Fresh oranges. Oranges are high in potassium and should be avoided by clients taking potassium-sparing diuretics.

Ripe bananas. Bananas are also high in potassium and should be avoided to prevent hyperkalemia.

A baked potato. Potatoes, especially baked potatoes with the skin, are high in potassium and should be limited in the diet of clients taking triamterene.

EXPLANATION

✔Correct answer:

Cranberry juice. Xanthine bronchodilators, such as theophylline, are used to treat respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD) by relaxing the bronchial muscles and opening up the airways. Patients taking these medications should avoid beverages containing caffeine and other xanthines, as these can increase the side effects of the medication, such as jitteriness, increased heart rate, and insomnia. Coffee, chocolate milk, and cola all contain caffeine or other xanthines, which can interact with xanthine bronchodilators and exacerbate side effects. Cranberry juice, on the other hand, does not contain caffeine or xanthines and is a safe choice.

Caffeine and other xanthines can potentiate the effects of xanthine bronchodilators, leading to increased central nervous system stimulation and potential toxicity. Avoiding these substances helps to maintain therapeutic drug levels and reduces the risk of adverse reactions.

Think of xanthine bronchodilators like a performance-enhancing fuel for a car engine. Adding more fuel of a similar type (like caffeine) can cause the engine to over-rev and potentially damage it. Choosing a different type of beverage (like cranberry juice) helps to keep the engine running smoothly without overloading it.

Nurse Johnson should ensure the patient understands the importance of avoiding caffeine and other xanthine-containing beverages while taking xanthine bronchodilators. This includes providing a list of common foods and drinks to avoid and suggesting safe alternatives.

• Educate the patient on reading labels to identify caffeine-containing products.
• Provide a list of safe beverage alternatives, such as water, herbal teas, and fruit juices like cranberry juice.
• Encourage the patient to report any side effects or symptoms of xanthine toxicity, such as restlessness, palpitations, or nausea.

✘Incorrect answer options:

Coffee. Coffee contains high levels of caffeine, which can interact with xanthine bronchodilators and increase the risk of side effects.

Chocolate milk. Chocolate contains theobromine, another xanthine, which can also potentiate the effects of xanthine bronchodilators.

Cola. Cola drinks typically contain caffeine, making them unsuitable for patients on xanthine bronchodilators.

EXPLANATION

✔Correct answer:

Rise slowly from lying down to a sitting position. Quinapril hydrochloride (Accupril) is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure. One of the common side effects of ACE inhibitors is orthostatic hypotension, which is a sudden drop in blood pressure when moving from a lying down to a sitting or standing position. This can cause dizziness or lightheadedness and increases the risk of falls, particularly in older adults.

Orthostatic hypotension occurs because ACE inhibitors cause vasodilation, which reduces blood pressure. When a person stands up quickly, gravity causes blood to pool in the lower extremities, and if the body cannot compensate quickly enough, blood pressure drops, leading to dizziness or fainting.

Imagine your blood pressure as a carefully balanced stack of books. If you try to move the stack quickly (standing up fast), the books can topple over (you feel dizzy). However, if you lift the stack slowly and steadily (rising slowly), the books remain balanced, and you avoid any problems.

Nurse Davis should advise the client to rise slowly from a lying or sitting position to prevent dizziness and reduce the risk of falls. Additionally, it is important to educate the client on the gradual onset of therapeutic effects and the correct method of taking the medication.

• Advise the client to take their time when moving from lying down to sitting or standing, to allow their body to adjust and prevent dizziness.
• Inform the client that therapeutic effects may take several weeks to be fully noticeable, and to continue taking the medication as prescribed.
• Explain that quinapril can be taken with or without food, providing flexibility in administration.
• Encourage the client to report any side effects, including persistent nausea, to their healthcare provider rather than stopping the medication abruptly.

✘Incorrect answer options:

Expect to see therapeutic effects immediately. The therapeutic effects of quinapril, like other ACE inhibitors, may take several weeks to become fully apparent. Clients should be advised to continue taking the medication as prescribed and not to expect immediate results.

Only take the medication with food. Quinapril can be taken with or without food. There is no strict requirement to take it only with food.

Stop taking the medication if you experience nausea. Clients should not stop taking prescribed medications without consulting their healthcare provider, even if they experience side effects such as nausea. The provider may adjust the dosage or suggest ways to manage side effects.

EXPLANATION

✔Correct answer:

The pharmacist, physician, and nurse all share liability for the error. In healthcare, patient safety is a shared responsibility, and the occurrence of an allergic reaction due to the administration of a known allergen implicates multiple healthcare providers involved in the medication administration process. Each professional has a duty to ensure patient safety, which includes cross-checking for documented allergies.

1. The Physician: The physician is responsible for reviewing the patient's medical history, including known allergies, before prescribing medications. In this case, the physician should have noted the penicillin allergy and prescribed an alternative antibiotic.
2. The Pharmacist: Pharmacists play a critical role in patient safety by reviewing prescriptions for potential drug interactions, contraindications, and allergies. The pharmacist should have checked the patient's allergy status and alerted the physician about the documented penicillin allergy before dispensing the medication.
3. The Nurse: Nurses are the last line of defense in preventing medication errors. Before administering any medication, nurses are responsible for verifying the "Five Rights" of medication administration (right patient, right medication, right dose, right route, and right time) and reviewing the patient’s allergy history. Nurse Emily should have double-checked the allergy status and held the medication, contacting the physician for clarification or an alternative order.

Consider a chain of command in a factory where a defect is found in a product. The designer, the quality inspector, and the assembler all have roles in ensuring the final product is free from defects. If a defective product is released, all parties share responsibility for the oversight.

Nurses should adopt a thorough approach to medication administration, including:

• Reviewing patient records and allergy documentation before administering medications.
• Communicating with pharmacists and physicians when discrepancies or concerns arise.
• Educating patients about their medications and potential allergies.

✘Incorrect answer options:

The pharmacist alone—responsible for alerting the floor about potential allergic reactions. While the pharmacist should check for allergies, the responsibility does not lie solely with them. It is a collaborative effort among all healthcare providers.

The nurse alone—responsible for verifying allergies before giving the medication. Although nurses must verify allergies before administering medications, they are not solely responsible. The prescribing physician and dispensing pharmacist also share this responsibility.

The physician alone—responsible for prescribing the medication, which the nurse is obligated to follow. The physician should indeed verify patient allergies before prescribing, but the nurse and pharmacist also have roles in safeguarding against such errors.

EXPLANATION

✔Correct answer:

Meperidine. Demerol is the brand name for the drug meperidine, which is an opioid analgesic used for the management of moderate to severe pain. When selecting the correct vial from the narcotics cabinet, Nurse Alex should look for a vial labeled "Meperidine." Ensuring the correct medication is selected is crucial for patient safety and effective pain management.

Meperidine works by binding to opioid receptors in the brain and spinal cord, reducing the perception of pain and altering the emotional response to pain. It is typically used in a postoperative setting to manage pain and improve patient comfort.

Think of the medication as a specific tool for a job. Just as you would need a specific type of screwdriver for a certain screw, you need the correct medication (meperidine) for managing postoperative pain effectively.

Nurse Alex should follow standard procedures for medication administration, including verifying the "Five Rights" (right patient, right medication, right dose, right route, and right time) and checking the medication label three times before administration.

• Verify the medication order and check the label on the vial to ensure it reads "Meperidine."
• Check the expiration date and ensure the medication is within the safe use period.
• Follow proper protocols for preparing and administering an intramuscular injection, including site selection and technique.
• Monitor the patient for efficacy and any potential adverse effects following administration.

✘Incorrect answer options:

Albuterol. Albuterol is a bronchodilator used for the treatment of respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). It is not used for pain management.

Simethicone. Simethicone is an anti-foaming agent used to relieve gas and bloating in the gastrointestinal tract. It has no analgesic properties and is not used for pain management.

Ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce fever, pain, and inflammation. While it can be used for pain management, it is not the same as Demerol (meperidine) and is not administered intramuscularly.

EXPLANATION

✔Correct answer:

Lactulose (Chronulac). In clients with advanced cirrhosis of the liver, difficulty tolerating protein can lead to the accumulation of ammonia in the blood, resulting in hepatic encephalopathy. Lactulose is a medication commonly prescribed to manage hepatic encephalopathy by reducing ammonia levels. It works by promoting the excretion of ammonia in the stool and reducing its absorption in the intestine.

In cirrhosis, the liver's ability to detoxify ammonia is impaired. Ammonia is a byproduct of protein metabolism and can accumulate to toxic levels in the bloodstream if not properly processed by the liver. Lactulose helps to lower blood ammonia levels by acidifying the colon, which converts ammonia to ammonium, a form that is not easily absorbed and is excreted in the stool.

Think of lactulose as a cleaning agent that helps flush out toxic substances (ammonia) from a system (the body) that can't clean itself properly due to a malfunction (liver cirrhosis).

Nurse Anderson should monitor the client’s bowel movements and ammonia levels regularly, as well as educate the client on the importance of taking lactulose as prescribed. It is also important to monitor for signs of dehydration or electrolyte imbalance, as lactulose can cause diarrhea.

• Administer lactulose as prescribed, usually orally or via enema.
• Monitor for effectiveness by checking ammonia levels and observing for improvements in mental status.
• Educate the client on the importance of adhering to the prescribed dosage to prevent hyperammonemia.
• Encourage the client to maintain hydration and report any excessive diarrhea or abdominal discomfort.

✘Incorrect answer options:

Folic acid (Folvite). Folic acid is often prescribed to clients with liver disease to prevent anemia, but it does not address the issue of elevated ammonia levels or protein intolerance directly.

Thiamine (Vitamin B1). Thiamine is important for preventing Wernicke’s encephalopathy in clients with alcoholism, but it does not reduce ammonia levels or help with protein intolerance in cirrhosis.

Ethacrynic acid (Edecrin). Ethacrynic acid is a loop diuretic used to treat edema, which is common in cirrhosis, but it does not address the specific issue of elevated ammonia levels or protein intolerance.

EXPLANATION

✔Correct answer:

Presence of proteinuria. Auranofin (Ridaura) is a gold compound used to treat rheumatoid arthritis by reducing inflammation and slowing disease progression. One of the serious adverse effects of auranofin is nephrotoxicity, which can manifest as proteinuria. The presence of proteinuria indicates that the kidneys are being adversely affected by the medication, and this requires immediate medical attention.

Proteinuria occurs when the kidneys' filtering units, called glomeruli, become damaged and allow proteins that are normally retained in the blood to pass into the urine. This can be an early sign of kidney damage or nephrotoxicity, which is a known potential adverse effect of gold compounds like auranofin.

Think of the kidneys as a coffee filter that’s supposed to keep the coffee grounds (proteins) from getting into your cup (urine). If the filter gets damaged, the grounds end up in your cup, indicating a problem with the filter, similar to how protein in the urine indicates kidney damage.

Nurse Smith should monitor the client’s urine for the presence of protein and other signs of kidney dysfunction regularly. If proteinuria or any other signs of nephrotoxicity are detected, it is crucial to report these findings to the healthcare provider immediately for further evaluation and possible adjustment or discontinuation of the medication.

• Regularly test the client's urine for protein and other abnormalities.
• Monitor renal function tests, such as blood urea nitrogen (BUN) and serum creatinine levels.
• Educate the client to report any signs of kidney issues, such as swelling, decreased urine output, or changes in urine color.

✘Incorrect answer options:

Persistent diarrhea. While diarrhea can be a side effect of auranofin, it is not as serious as proteinuria in terms of indicating a potentially severe adverse effect requiring immediate medical attention.

Lack of appetite (anorexia). Anorexia can also occur with auranofin use, but it is a more common and less severe side effect compared to proteinuria.

Episodes of nausea. Nausea is a common side effect of many medications, including auranofin, but it does not indicate a severe adverse effect like proteinuria does.

EXPLANATION

✔Correct answer:

Check the patient’s wristband. Verifying the patient's identity using their wristband is considered the best practice to ensure accurate patient identification before administering any medication. This practice is crucial for patient safety and is part of the "Five Rights" of medication administration (right patient, right medication, right dose, right route, and right time). The wristband typically contains the patient's name, date of birth, and medical record number, which should be cross-checked with the medication order and the patient's medical records.

Patient misidentification can lead to serious medication errors, adverse drug reactions, and potential harm. By checking the wristband, Nurse Laura can confirm that she is administering the medication to the correct patient, thus minimizing the risk of error.

Think of a wristband as a ticket to a concert. Just as you would verify your ticket to ensure you enter the right concert, a wristband verifies the patient's identity to ensure they receive the correct treatment.

When verifying patient identity, Nurse Laura should:

• Ask the patient to state their name and date of birth.
• Compare this information with the details on the wristband.
• Cross-check the information with the medication order and the patient's medical record.
• Ensure that the patient’s wristband is always in place and legible.

✘Incorrect answer options:

Call the patient by name. While calling the patient by name can be part of the identification process, it is not sufficient on its own, especially in settings where patients may have similar or identical names.

Read the patient’s name on the door. The name on the door might not always be accurate or up-to-date, especially if patients are moved to different rooms or if room assignments change frequently.

Verify the patient’s room number on the unit census list. Relying solely on room numbers can be problematic as patients may be transferred to different rooms, and room numbers alone do not confirm the patient's identity.

EXPLANATION

✔Correct answer:

Calm the persistent cough. Benzonatate (Tessalon) is an antitussive medication used to relieve coughing. It works by numbing the throat and lungs, making the cough reflex less active. This helps to reduce the frequency and intensity of coughing, providing relief to the client who has been experiencing a persistent cough.

Benzonatate acts by anesthetizing the stretch receptors located in the respiratory passages, lungs, and pleura (the membranes lining the chest cavity). When these receptors are less sensitive, the cough reflex is diminished, leading to a reduction in coughing episodes.

Think of benzonatate as a "mute button" for your cough. Just like pressing the mute button on your TV stops the sound, benzonatate numbs the receptors in your throat and lungs to quiet the cough.

Nurse Reynolds should educate the client on the correct use of benzonatate and emphasize the importance of not chewing or crushing the capsules, as this can cause numbness in the mouth and throat. The nurse should also instruct the client on the potential side effects and the importance of following the prescribed dosage.

• Instruct the client to swallow benzonatate capsules whole with water and not to chew, crush, or dissolve them.
• Explain that the medication helps to reduce the cough reflex and provide relief from persistent coughing.
• Inform the client about possible side effects, such as drowsiness, dizziness, or numbness in the mouth or throat if the capsule is chewed or broken.
• Advise the client to contact their healthcare provider if the cough persists or worsens despite taking the medication.

✘Incorrect answer options:

Decrease anxiety levels. Benzonatate is not an anxiolytic and does not affect anxiety levels. It is specifically used to treat coughing.

Increase overall comfort. While reducing a persistent cough can increase comfort, this is a general effect rather than the specific action of the medication.

Alleviate nausea and vomiting. Benzonatate does not have antiemetic properties and is not used to treat nausea or vomiting. It is specifically an antitussive medication.

EXPLANATION

✔Correct answer:

Accumulate. In geriatric patients, the physiological changes associated with aging, particularly diminished liver and kidney function, can significantly affect drug metabolism and excretion. The liver is primarily responsible for metabolizing drugs, and the kidneys are responsible for excreting them. As these organs' functions decline with age, the body's ability to clear medications diminishes, leading to drug accumulation.

Digoxin is a cardiac glycoside used to treat heart conditions such as atrial fibrillation and heart failure. It has a narrow therapeutic index, meaning the difference between a therapeutic and toxic dose is small. Reduced renal function in the elderly impairs the excretion of digoxin, which can lead to accumulation and an increased risk of toxicity. Symptoms of digoxin toxicity include nausea, vomiting, dizziness, confusion, and cardiac arrhythmias.

Imagine pouring water into a glass with a narrow outlet. If the outlet (representing kidney function) is partially blocked or narrowed, the water (medication) will accumulate in the glass because it can't exit as quickly as it's being poured in.

Nurses should monitor elderly patients closely for signs of drug toxicity and adjust dosages based on renal function tests and clinical response. Regular blood tests to measure drug levels can help in adjusting the dose to avoid toxicity.

• Assess renal function regularly through blood tests (e.g., serum creatinine, glomerular filtration rate).
• Monitor for signs and symptoms of digoxin toxicity, such as gastrointestinal disturbances, vision changes, and cardiac arrhythmias.
• Educate patients and their families about the importance of adhering to prescribed doses and reporting any unusual symptoms immediately.
• Collaborate with pharmacists and physicians to ensure appropriate dosing and adjustments as needed.

✘Incorrect answer options:

Have decreased distribution. Decreased distribution can occur due to changes in body composition, such as decreased muscle mass and increased fat tissue, but this is not the primary issue related to altered dosing in geriatric patients for drugs like digoxin.

Have increased absorption. Absorption generally refers to the initial entry of the drug into the bloodstream from the site of administration. Aging does not significantly affect the absorption of digoxin; instead, it mainly affects the drug's metabolism and excretion.

Have a shorter half-life. The half-life of a drug is the time it takes for the plasma concentration to reduce by half. In elderly patients, the half-life of digoxin would actually be prolonged due to decreased renal clearance, leading to accumulation, not a shorter half-life.

EXPLANATION

✔Correct answer:

Report the findings to the RN and request an alternative pain medication. Nurse Lily should report the findings to the RN and request an alternative pain medication. The patient's current vital signs indicate hypotension (BP 92/60) and bradypnea (respirations 10), which are concerning and could indicate opioid-induced respiratory depression. Administering more morphine could exacerbate these conditions, potentially leading to life-threatening respiratory failure.

Morphine is an opioid analgesic that can cause central nervous system depression, leading to decreased respiratory rate and blood pressure. The patient’s significant drop in blood pressure and respiratory rate suggests that she may already be experiencing some degree of opioid toxicity. Continuing with the current morphine dosage could worsen her condition, thus it is crucial to reassess her pain management plan.

Imagine you are driving a car that is overheating. Instead of continuing to drive and risking severe engine damage, you would stop and reassess the situation, perhaps seeking alternative solutions like adding coolant or calling for help. Similarly, Nurse Lily needs to reassess the situation and seek alternatives to avoid worsening Mrs. Wilson's condition.

Nurse Lily should immediately report the patient's vital signs and symptoms to the supervising RN and suggest discussing the case with the physician to consider alternative pain management options that do not pose the same risks. Non-opioid pain management strategies or different classes of pain medications may be more appropriate in this situation.

• Monitor the patient closely for any further signs of opioid toxicity, such as increased drowsiness, confusion, or further respiratory depression.
• Utilize non-pharmacological pain relief methods, such as comfort measures, while awaiting further orders.
• Document the patient's vital signs, symptoms, and any interventions performed in her medical record.

✘Incorrect answer options:

Administer the next scheduled dose of Morphine sulfate. Given the patient's current vital signs, administering more morphine could lead to further respiratory depression and hypotension, which could be dangerous.

Offer comfort measures such as a back rub, light music, and dimming the lights. While these comfort measures can be helpful adjuncts for pain management, they are not sufficient as a sole intervention given the severity of Mrs. Wilson's pain and her current physiological status.

Obtain further orders from the physician. While ultimately obtaining further orders is necessary, the immediate step should be to report the findings to the RN to initiate the process. The RN can help expedite the necessary actions and ensure that the situation is managed appropriately and swiftly.

EXPLANATION

✔Correct answer:

Avoid exposure to direct sunlight. Ketoconazole (Nizoral) is an antifungal medication used to treat various fungal infections, including histoplasmosis. One of the important precautions patients should take while on ketoconazole is to avoid exposure to direct sunlight. Ketoconazole can increase the skin's sensitivity to sunlight, leading to a higher risk of sunburn and phototoxic reactions.

Photosensitivity is a common side effect of many medications, including ketoconazole. When the skin is exposed to UV rays from the sun, it can react more intensely than normal, causing severe sunburn, rashes, or other skin reactions. By avoiding direct sunlight and using protective measures like wearing sunscreen, patients can minimize these risks.

Think of ketoconazole as making your skin like very delicate fabric that can easily get damaged by the sun. Just as you would protect a delicate fabric from harsh sunlight to prevent it from fading or tearing, you need to protect your skin while taking this medication.

Nurse Harper should educate the patient on the importance of sun protection while taking ketoconazole. This includes advising the patient to:

• Avoid direct sunlight, especially during peak hours (10 a.m. to 4 p.m.).
• Wear protective clothing, such as long sleeves, hats, and sunglasses.
• Apply broad-spectrum sunscreen with an SPF of 30 or higher.
• Seek shade whenever possible.

✘Incorrect answer options:

Take the medication along with an antacid. Antacids can interfere with the absorption of ketoconazole, reducing its effectiveness. It is generally recommended to avoid taking antacids within 2 hours before or after taking ketoconazole.

Take the medication on an empty stomach. Ketoconazole should be taken with food to enhance its absorption and reduce gastrointestinal side effects.

Limit alcohol intake to 2 ounces per day. While it is always advisable to limit alcohol intake, this specific instruction is not the most crucial advice related to ketoconazole. Alcohol can increase the risk of liver toxicity, which is a concern with ketoconazole, but the key instruction for photosensitivity takes precedence in this context.

EXPLANATION

✔Correct answer:

A glycerin-based emollient. Glycerin-based emollients are highly effective for treating dry and irritated skin. Glycerin is a humectant, which means it helps attract and retain moisture in the skin. Emollients are substances that soften and moisturize the skin and decrease itching and flaking. By applying a glycerin-based emollient, the client can hydrate the skin and create a protective barrier to prevent further moisture loss, thus relieving dryness and irritation.

Dry skin occurs when the outer layer of the skin, the epidermis, loses moisture and essential oils. This can lead to cracking, irritation, and an increased risk of infection. Glycerin-based emollients work by forming a protective layer on the skin's surface and drawing moisture into the skin from the surrounding environment.

Think of glycerin-based emollients as a raincoat for your skin. Just as a raincoat keeps you dry by repelling water and sealing in warmth, glycerin-based emollients keep the skin hydrated by trapping moisture and preventing it from escaping.

Nurse Thompson should recommend the following steps for the client to effectively manage dry skin with a glycerin-based emollient:

• Apply the emollient immediately after bathing while the skin is still damp to lock in moisture.
• Use the emollient regularly, at least twice a day, or as needed to maintain skin hydration.
• Avoid hot water and harsh soaps that can strip the skin of natural oils; opt for lukewarm water and gentle, fragrance-free cleansers.
• Wear soft, breathable fabrics to reduce irritation and friction on the skin.

✘Incorrect answer options:

A topical Aspercreme. Aspercreme contains trolamine salicylate, which is used to relieve minor aches and pains in muscles and joints, not for treating dry skin.

Myoflex cream. Myoflex is also used to relieve muscle and joint pain, not for moisturizing or treating dry skin.

An acetic acid solution. Acetic acid solutions are typically used as antiseptics or for other specific medical treatments, but they are not suitable for hydrating dry skin and could potentially cause further irritation.

EXPLANATION

✔Correct answer:

Acetaminophen (Tylenol). Famotidine (Pepcid) is a histamine H2 receptor antagonist used to reduce stomach acid production, commonly prescribed for conditions like gastroesophageal reflux disease (GERD) or ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen can irritate the stomach lining and increase the risk of gastrointestinal bleeding or ulcers, which could counteract the protective effects of famotidine. Acetaminophen, on the other hand, is not an NSAID and does not have the same risk of gastrointestinal irritation, making it the safest choice for a client concerned about stomach issues.

NSAIDs inhibit the cyclooxygenase (COX) enzymes, which are involved in the formation of prostaglandins that protect the stomach lining. By reducing prostaglandin levels, NSAIDs can compromise the stomach's defense mechanisms against acid, leading to irritation and potential bleeding. Famotidine works by reducing acid production, so it is counterproductive to use medications that could harm the stomach lining.

Imagine you are using a fire extinguisher (famotidine) to put out a small fire (stomach acid). Using NSAIDs would be like adding more flammable material to the fire, making the situation worse. Acetaminophen, however, does not add any flammable material and is safe to use.

Nurse Taylor should recommend acetaminophen (Tylenol) for headache relief in clients taking famotidine to minimize the risk of gastrointestinal complications. Additionally, Nurse Taylor should educate the client on the importance of choosing medications that do not irritate the stomach lining.

• Explain the difference between NSAIDs and acetaminophen regarding their effects on the stomach lining.
• Advise the client to take acetaminophen according to the recommended dosage to avoid potential liver toxicity.
• Encourage the client to report any persistent or worsening symptoms to their healthcare provider.

✘Incorrect answer options:

Ibuprofen (Motrin). Ibuprofen is an NSAID that can irritate the stomach lining and increase the risk of gastrointestinal bleeding or ulcers, especially in clients taking famotidine.

Aspirin (acetylsalicylic acid, ASA). Aspirin is another NSAID with similar risks to ibuprofen, including stomach irritation and increased bleeding risk.

Naproxen (Naprosyn). Naproxen is an NSAID that also carries the risk of gastrointestinal irritation and bleeding, making it unsuitable for clients taking famotidine.

EXPLANATION

✔Correct answer:

Right frequency. The "five rights" of medication administration are a set of guidelines that healthcare professionals follow to ensure safe and effective medication administration. They include the right patient, right medication, right dose, right route, and right time. These principles help prevent medication errors and ensure patient safety.

Ensuring the correct administration of medications involves verifying multiple factors to prevent adverse reactions, underdosing, or overdosing, which can lead to ineffective treatment or harm. The "five rights" serve as a fundamental checklist to safeguard against these risks.

Think of the "five rights" as a recipe checklist for baking a cake. If you follow each step correctly, the cake turns out well. If you miss an ingredient or step, the outcome can be disastrous. Similarly, following the "five rights" ensures the medication process is safe and effective.

Nurse Williams should always follow the "five rights" to ensure proper medication administration. Here is a brief overview:

• Right patient: Verify the patient’s identity using at least two identifiers (e.g., name and date of birth).
• Right medication: Check the medication against the physician’s order and medication kardex.
• Right dose: Confirm that the dosage is appropriate for the patient’s age, weight, and condition.
• Right route: Ensure the medication is administered via the correct route (e.g., oral, intravenous, intramuscular).
• Right time: Administer the medication at the correct time as per the order, considering any specific timing requirements.

✘Incorrect answer options:

Right route. This is one of the five "rights" and refers to administering the medication via the correct method, such as orally or intravenously.

Right time. This is also one of the five "rights" and ensures the medication is given at the appropriate time intervals.

Right dose. This right ensures that the correct dosage is given based on the patient's needs and the physician’s order.

EXPLANATION

✔Correct answer:

Complete the entire course of medication, even if you start feeling better before it's finished. The most crucial advice Nurse Sarah should provide to Ms. Carter is to complete the entire course of ampicillin, even if she starts feeling better before it is finished. This advice is essential to ensure the effectiveness of the treatment and to prevent the development of antibiotic-resistant bacteria. When patients stop taking antibiotics prematurely, the bacteria causing the infection may not be completely eradicated, potentially leading to a recurrence of the infection or the development of resistant strains.

Antibiotics like ampicillin work by killing or inhibiting the growth of bacteria. If the full course is not completed, some bacteria may survive, which can lead to a resurgence of the infection. Moreover, these surviving bacteria can develop resistance to the antibiotic, making future infections harder to treat.

Think of taking antibiotics like weeding a garden. If you stop pulling weeds halfway through, the remaining weeds can spread again, making your garden overgrown and harder to manage in the future. Completing the full course of antibiotics ensures that all the "weeds" (bacteria) are effectively dealt with.

Nurse Sarah should emphasize the importance of completing the antibiotic course and educate Ms. Carter on the potential consequences of not doing so. She should also address any concerns Ms. Carter may have about side effects and provide instructions on what to do if she experiences adverse reactions.

• Explain the importance of completing the full course of antibiotics.
• Discuss potential side effects and what to do if they occur.
• Encourage Ms. Carter to keep a medication schedule or use reminders to ensure she does not miss doses.
• Advise Ms. Carter to store the medication as directed and keep it out of reach of children.

✘Incorrect answer options:

Do not share your medication with anyone else, regardless of their symptoms. While this is important advice, it is not the most crucial point regarding the effectiveness and safety of the prescribed antibiotic treatment.

Contact your doctor immediately if you experience any difficulty breathing. This advice is crucial if an allergic reaction occurs, but it is specific to immediate safety rather than ensuring the overall effectiveness of the antibiotic treatment.

Take the medication with food to avoid stomach upset. Although this can be useful advice for minimizing gastrointestinal side effects, it is not universally necessary for all antibiotics and does not address the primary concern of ensuring the full course of treatment is completed to effectively treat the infection and prevent resistance.

EXPLANATION

✔Correct answer:

Use a new vial to draw the insulin dose. Observing a clumpy precipitate inside an insulin vial indicates that the insulin may have been compromised. Insulin should appear uniformly cloudy or clear (depending on the type), without any visible clumps or particles. Clumps can suggest that the insulin has been contaminated, is expired, or has been improperly stored, which can affect its efficacy and safety.

Insulin is a hormone used to regulate blood glucose levels in patients with diabetes. If the insulin's integrity is compromised, it can lead to ineffective glucose control, causing either hyperglycemia or hypoglycemia. Administering compromised insulin could result in unpredictable blood sugar levels and potential harm to the patient.

Imagine using spoiled milk to make a cup of coffee. The milk might curdle and ruin the coffee, making it undrinkable. Similarly, using compromised insulin could render it ineffective or unsafe for the patient.

Nurse Kelly should discard the vial with the clumpy precipitate and use a new vial to ensure the insulin is safe and effective for administration. She should also report the compromised vial to the pharmacy or the appropriate personnel to prevent further use.

• Inspect all insulin vials before use to ensure there are no clumps or discoloration.
• Store insulin according to manufacturer guidelines, typically in a refrigerator at a temperature of 36°F to 46°F (2°C to 8°C).
• Educate patients and caregivers on proper insulin storage and inspection techniques.

✘Incorrect answer options:

Draw up and administer the insulin as is. Administering insulin with visible clumps could be unsafe and ineffective, potentially harming the patient.

Shake the vial to try and disperse the clumps. Shaking insulin vials can damage the insulin molecules, making it less effective. Properly mixing insulin should involve gentle rolling, not shaking.

Warm the vial under running water to dissolve the clumps. Warming the vial is not an appropriate method to address clumps in insulin. Insulin should be kept at a consistent, appropriate temperature, and warming could further compromise the medication.