Clinical Nurse Specialist Pharmacology & Medication Management Flashcards

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?

Answer: Bradycardia and visual disturbances

Digoxin toxicity classically presents with bradycardia, heart block, nausea, and yellow-green visual disturbances (xanthopsia).

When initiating heparin infusion for a patient with a PE, which laboratory value guides dose adjustments?

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.

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?

Answer: Prednisone

Corticosteroids such as prednisone cause steroid-induced hyperglycemia by increasing hepatic glucose production and inducing insulin resistance.

A CNS is counseling a patient prescribed warfarin about dietary interactions. Which food should be consumed consistently rather than avoided entirely?

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.

Which antiepileptic drug requires monitoring for hyponatremia due to its SIADH-like effect?

Answer: Carbamazepine

Carbamazepine can cause SIADH, leading to hyponatremia, and sodium levels must be monitored especially in elderly patients.

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?

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.