MSNCB Pharmacology & Medication Management 5 — Questions and Answers
Question 1: A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis. Which laboratory value requires the most frequent monitoring?
- Prothrombin time (PT)
- Platelet count (Correct answer)
- Activated partial thromboplastin time (aPTT)
- International normalized ratio (INR)
Correct answer: Platelet count
Platelet counts must be monitored with enoxaparin to detect heparin-induced thrombocytopenia (HIT), which can occur with low molecular weight heparins.
Question 2: A nurse is preparing to give oral medications to a patient with a new nasogastric tube. Which medication should NOT be crushed?
- Acetaminophen tablet
- Omeprazole delayed-release capsule (Correct answer)
- Metoprolol tartrate immediate-release
- Docusate sodium capsule contents
Correct answer: Omeprazole delayed-release capsule
Omeprazole is an enteric-coated delayed-release formulation that should not be crushed as this destroys the protective coating and inactivates the drug in the stomach.
Question 3: Which intervention is most important when administering IV potassium chloride?
- Administer undiluted via IV push for fastest effect
- Infuse at a rate no faster than 10–20 mEq/hour (Correct answer)
- Use a peripheral line for concentrations above 40 mEq/100 mL
- Warm the solution before administration to improve absorption
Correct answer: Infuse at a rate no faster than 10–20 mEq/hour
IV potassium must be infused slowly (≤10–20 mEq/hour via peripheral line) because rapid administration can cause fatal cardiac dysrhythmias.
Question 4: A patient prescribed tamsulosin (Flomax) for benign prostatic hyperplasia is about to undergo cataract surgery. The nurse should alert the surgical team because tamsulosin is associated with:
- Prolonged bleeding time
- Intraoperative floppy iris syndrome (IFIS) (Correct answer)
- Malignant hyperthermia
- Increased intraocular pressure
Correct answer: Intraoperative floppy iris syndrome (IFIS)
Alpha-1 blockers like tamsulosin relax the iris dilator muscle, causing IFIS during cataract surgery and increasing the risk of serious intraoperative complications.
Question 5: A patient taking lithium for bipolar disorder presents with tremors, confusion, and vomiting. Serum lithium level is 2.2 mEq/L. The nurse anticipates which treatment?
- Increasing lithium dose to achieve therapeutic level
- Hemodialysis to rapidly remove lithium (Correct answer)
- Administering sodium bicarbonate IV
- Providing supportive care with oral hydration only
Correct answer: Hemodialysis to rapidly remove lithium
Lithium levels >2.0 mEq/L indicate severe toxicity with neurologic symptoms; hemodialysis is the most effective method to rapidly eliminate lithium.
Question 6: A post-operative patient is prescribed patient-controlled analgesia (PCA) with morphine. Which nursing action is essential for safe PCA management?
- Allow family members to press the PCA button if the patient is sleeping
- Assess pain and sedation level every 1–2 hours (Correct answer)
- Set the lockout interval to 5 minutes for adequate pain control
- Encourage the patient to press the button before pain becomes severe
Correct answer: Assess pain and sedation level every 1–2 hours
Regular assessment of pain and sedation level every 1–2 hours is essential to detect early signs of opioid-induced respiratory depression with PCA therapy.
Question 7: A nurse is teaching a patient about taking oral iron supplements. Which instruction will maximize iron absorption?
- Take iron with milk to reduce gastrointestinal irritation
- Take iron with a glass of orange juice on an empty stomach (Correct answer)
- Take iron with calcium-rich foods to enhance bioavailability
- Take iron with coffee or tea to improve tolerability
Correct answer: Take iron with a glass of orange juice on an empty stomach
Vitamin C in orange juice enhances non-heme iron absorption, and taking iron on an empty stomach maximizes gastrointestinal uptake despite potential GI upset.
MSNCB Pharmacology & Medication Management 5
A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis.
Which laboratory value requires the most frequent monitoring?