Clinical Nurse Specialist Clinical Nurse Specialist Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A CNS is reconciling medications for a patient admitted with a digoxin level of 3.2 ng/mL. Which symptom is most consistent with digoxin toxicity?
- Hypertension
- Bradycardia and visual disturbances (Correct answer)
- Tachycardia and flushing
- Hyperglycemia
Correct answer: Bradycardia and visual disturbances
Digoxin toxicity classically presents with bradycardia, heart block, nausea, and yellow-green visual disturbances (xanthopsia).
Question 2: When initiating heparin infusion for a patient with a PE, which laboratory value guides dose adjustments?
- INR
- Anti-Xa level or aPTT (Correct answer)
- Platelet count only
- Thrombin time
Correct answer: Anti-Xa level or aPTT
The aPTT (or anti-Xa level) is used to titrate unfractionated heparin infusions to maintain therapeutic anticoagulation per weight-based nomograms.
Question 3: A CNS notes that a patient's blood glucose is persistently elevated despite insulin therapy. What medication on the patient's list is most likely contributing?
- Metoprolol
- Prednisone (Correct answer)
- Lisinopril
- Furosemide
Correct answer: Prednisone
Corticosteroids such as prednisone cause steroid-induced hyperglycemia by increasing hepatic glucose production and inducing insulin resistance.
Question 4: A CNS is counseling a patient prescribed warfarin about dietary interactions. Which food should be consumed consistently rather than avoided entirely?
- Grapefruit
- Vitamin K-rich foods like leafy greens (Correct answer)
- High-fat foods
- Dairy products
Correct answer: Vitamin K-rich foods like leafy greens
Patients on warfarin should maintain consistent (not eliminate) intake of vitamin K-rich foods because fluctuations alter INR more than steady consumption.
Question 5: Which antiepileptic drug requires monitoring for hyponatremia due to its SIADH-like effect?
- Phenytoin
- Levetiracetam
- Carbamazepine (Correct answer)
- Valproic acid
Correct answer: Carbamazepine
Carbamazepine can cause SIADH, leading to hyponatremia, and sodium levels must be monitored especially in elderly patients.
Question 6: A CNS is implementing a medication reconciliation process on a busy medical-surgical unit. What is the most effective strategy to reduce errors at transitions of care?
- Have the charge nurse verify orders once per shift
- Require pharmacist-led reconciliation at admission, transfer, and discharge (Correct answer)
- Use verbal orders for efficiency during handoffs
- Reconcile only high-risk medications
Correct answer: Require pharmacist-led reconciliation at admission, transfer, and discharge
Pharmacist-led medication reconciliation at every care transition is evidence-based and significantly reduces discrepancies that cause patient harm.
Clinical Nurse Specialist Clinical Nurse Specialist Pharmacology & Medication Management 2
A CNS is reconciling medications for a patient admitted with a digoxin level of 3.2 ng/mL.
Which symptom is most consistent with digoxin toxicity?