NCSBN - National Council of State Boards of Nursing Pharmacological Therapies Questions and Answers — Questions and Answers
Question 1: A nurse is providing discharge teaching to a client newly prescribed warfarin. Which statement by the client indicates a need for further education?
- "I will use an electric razor for shaving instead of a disposable razor."
- "I will start taking ibuprofen for my occasional headaches." (Correct answer)
- "I must report any signs of dark, tarry stools to my provider."
- "I understand I will need to have my blood tested regularly."
Correct answer: "I will start taking ibuprofen for my occasional headaches."
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen increase the risk of bleeding when taken concurrently with warfarin. The nurse must instruct the client to use acetaminophen for pain relief instead. The other statements indicate a correct understanding of bleeding precautions and the required laboratory monitoring (INR/PT).
Question 2: A nurse is reviewing the laboratory results for a client receiving intravenous furosemide for acute heart failure. Which laboratory value requires the most immediate intervention?
- Serum sodium 137 mEq/L
- Blood urea nitrogen (BUN) 25 mg/dL
- Serum potassium 2.8 mEq/L (Correct answer)
- Serum creatinine 1.2 mg/dL
Correct answer: Serum potassium 2.8 mEq/L
Furosemide is a potent loop diuretic that causes the excretion of potassium. A serum potassium level of 2.8 mEq/L is critically low (hypokalemia) and places the client at high risk for life-threatening cardiac dysrhythmias. This finding must be reported to the provider immediately. The other lab values are either within normal limits or not as immediately critical.
Question 3: A nurse assesses a client receiving morphine via a patient-controlled analgesia (PCA) pump. The client's respiratory rate is 7 breaths/min and they are difficult to arouse. After stopping the PCA infusion, what is the nurse's next priority action?
- Check the client's oxygen saturation level.
- Notify the healthcare provider of the findings.
- Document the client's status in the electronic health record.
- Administer naloxone as prescribed by standing order. (Correct answer)
Correct answer: Administer naloxone as prescribed by standing order.
The client is exhibiting signs of severe opioid-induced respiratory depression, which is a life-threatening emergency. After stopping the opioid infusion to prevent further administration, the priority action is to reverse the respiratory depression by administering the opioid antagonist, naloxone. While checking oxygen saturation and notifying the provider are important, they are not the immediate priority over administering the life-saving antidote.
Question 4: A nurse is preparing to administer an intravenous infusion of vancomycin. To prevent the occurrence of vancomycin flushing syndrome ("Red Man Syndrome"), which nursing action is most appropriate?
- Infuse the medication over at least 60 minutes. (Correct answer)
- Administer a rapid IV bolus over 5 minutes.
- Cover the client with a warming blanket during the infusion.
- Pre-medicate the client with an antiemetic.
Correct answer: Infuse the medication over at least 60 minutes.
Vancomycin flushing syndrome is a rate-dependent infusion reaction caused by histamine release, not a true allergic reaction. The primary strategy to prevent it is to infuse the medication slowly, over a period of at least 60 to 90 minutes. Administering it as a rapid bolus would cause the reaction. Pre-medication with antihistamines, not antiemetics, may also be ordered.
Question 5: A client who was prescribed lisinopril two weeks ago reports developing a persistent, nonproductive cough. Which of the following is the nurse's best response?
- "You are likely developing a respiratory infection and should see your provider for an antibiotic."
- "This is an expected and common side effect. You should notify your provider to discuss potential medication changes." (Correct answer)
- "Stop taking the medication immediately as this indicates a severe allergic reaction."
- "Increase your fluid intake to help thin the secretions causing the cough."
Correct answer: "This is an expected and common side effect. You should notify your provider to discuss potential medication changes."
A persistent, dry, hacking cough is a well-known and common side effect of ACE inhibitors like lisinopril, related to the accumulation of bradykinin. It is not an allergic reaction or a sign of infection. The most appropriate response is to validate the client's experience, identify it as a known side effect, and direct them to consult their provider, who may prescribe an alternative antihypertensive like an ARB.
Question 6: A nurse is providing education to a 22-year-old client newly prescribed fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI). Which instruction is most critical for the nurse to include?
- "You must avoid eating aged cheese and cured meats while on this medication."
- "The medication should provide full relief from your symptoms within one week."
- "It is crucial to immediately report any increase in suicidal thoughts or behaviors." (Correct answer)
- "You can stop taking the medication as soon as you start to feel better."
Correct answer: "It is crucial to immediately report any increase in suicidal thoughts or behaviors."
All antidepressant medications, including SSRIs, carry a black box warning from the FDA regarding an increased risk of suicidal thinking and behavior, particularly in children, adolescents, and young adults (up to age 24) during the initial weeks of treatment. This is the most critical safety instruction. The dietary restrictions mentioned apply to MAOIs, therapeutic effects take several weeks to develop, and the medication should never be stopped abruptly.
NCSBN - National Council of State Boards of Nursing Pharmacological Therapies Questions and Answers
A nurse is providing discharge teaching to a client newly prescribed warfarin.
Which statement by the client indicates a need for further education?