Clinical Nurse Specialist Clinical Nurse Specialist Pharmacology & Medication Management 1 — Questions and Answers
Question 1: A CNS is reviewing a patient's medication list and notes a new prescription for warfarin alongside daily aspirin. What is the primary concern?
- Reduced anticoagulant effect
- Increased bleeding risk due to additive antiplatelet effects (Correct answer)
- Decreased aspirin absorption
- Warfarin-induced hepatotoxicity
Correct answer: Increased bleeding risk due to additive antiplatelet effects
Concurrent use of warfarin and aspirin increases bleeding risk because aspirin's antiplatelet effect is additive to warfarin's anticoagulation.
Question 2: When counseling a patient starting metformin for type 2 diabetes, which side effect should the CNS emphasize as most common?
- Hypoglycemia
- Weight gain
- Gastrointestinal upset (Correct answer)
- Pancreatitis
Correct answer: Gastrointestinal upset
Gastrointestinal symptoms such as nausea, diarrhea, and abdominal discomfort are the most common side effects of metformin, especially at initiation.
Question 3: A patient on lisinopril develops a dry, persistent cough. What is the CNS's best recommendation?
- Add an antitussive medication
- Switch to an angiotensin receptor blocker (ARB) (Correct answer)
- Discontinue all antihypertensives
- Increase fluid intake to suppress cough
Correct answer: Switch to an angiotensin receptor blocker (ARB)
ACE inhibitor-induced cough is a class effect; switching to an ARB provides equivalent blood pressure control without bradykinin-mediated cough.
Question 4: Which monitoring parameter is most critical when a CNS initiates vancomycin therapy in a hospitalized patient?
- Liver function tests
- Serum potassium
- Renal function and vancomycin trough levels (Correct answer)
- Complete blood count
Correct answer: Renal function and vancomycin trough levels
Vancomycin is nephrotoxic, so renal function and trough serum levels must be closely monitored to guide dosing and prevent toxicity.
Question 5: A CNS reviews an order for morphine 4 mg IV q4h PRN for a postoperative patient. The patient has a respiratory rate of 8 breaths/min. What is the priority action?
- Administer the dose as ordered
- Hold the dose and reassess in 30 minutes
- Hold the dose, notify the provider, and prepare naloxone (Correct answer)
- Reduce the dose by half and administer
Correct answer: Hold the dose, notify the provider, and prepare naloxone
Respiratory depression is a life-threatening opioid side effect; the CNS must hold the dose, alert the prescriber, and have naloxone ready for reversal.
Question 6: Which drug-drug interaction is most clinically significant when a CNS manages a patient taking both simvastatin and clarithromycin?
- Decreased antibiotic efficacy
- Elevated simvastatin levels causing rhabdomyolysis risk (Correct answer)
- Reduced statin absorption
- Prolonged QT interval only
Correct answer: Elevated simvastatin levels causing rhabdomyolysis risk
Clarithromycin inhibits CYP3A4, raising simvastatin plasma levels dramatically and increasing the risk of myopathy and rhabdomyolysis.
Clinical Nurse Specialist Clinical Nurse Specialist Pharmacology & Medication Management 1
A CNS is reviewing a patient's medication list and notes a new prescription for warfarin alongside daily aspirin.
What is the primary concern?