Next Next Pharmacology and Medication Management 2 — Questions and Answers
Question 1: A patient is allergic to penicillin. Which antibiotic class requires the MOST caution due to cross-reactivity?
- Macrolides (e.g., azithromycin)
- Cephalosporins (e.g., cephalexin) (Correct answer)
- Fluoroquinolones (e.g., ciprofloxacin)
- Tetracyclines (e.g., doxycycline)
Correct answer: Cephalosporins (e.g., cephalexin)
Cephalosporins share a similar beta-lactam ring structure with penicillin, and cross-reactivity — while less common than historically thought — still requires caution and careful assessment.
Question 2: Morphine 4 mg IV is ordered. The vial contains 10 mg/mL. How many mL should the nurse draw up?
- 0.2 mL
- 0.4 mL (Correct answer)
- 2.5 mL
- 4 mL
Correct answer: 0.4 mL
Using the formula: dose desired ÷ dose on hand × volume = 4 mg ÷ 10 mg × 1 mL = 0.4 mL.
Question 3: Which adverse effect is MOST associated with aminoglycoside antibiotics (e.g., gentamicin)?
- Hepatotoxicity and jaundice
- Nephrotoxicity and ototoxicity (Correct answer)
- Bone marrow suppression
- QT prolongation and dysrhythmias
Correct answer: Nephrotoxicity and ototoxicity
Aminoglycosides accumulate in the renal cortex and cochlea, making nephrotoxicity and ototoxicity their most clinically significant adverse effects requiring monitoring.
Question 4: A patient on heparin infusion has an aPTT of 180 seconds. The normal range is 30–40 seconds and the therapeutic range is 60–80 seconds. The nurse should:
- Increase the heparin infusion rate
- Continue the current infusion and recheck in 6 hours
- Stop the infusion and notify the prescriber immediately (Correct answer)
- Administer protamine sulfate without waiting for orders
Correct answer: Stop the infusion and notify the prescriber immediately
An aPTT of 180 seconds is far above the therapeutic range, indicating excessive anticoagulation and high bleeding risk; the infusion must be stopped and the prescriber notified immediately.
Question 5: Which instruction is MOST important to give a patient who is prescribed a bisphosphonate (e.g., alendronate) for osteoporosis?
- Take the medication at bedtime with a full glass of milk
- Take the medication with a full glass of water and remain upright for 30–60 minutes (Correct answer)
- Crush the tablet and mix it with juice if swallowing is difficult
- Take the medication with a high-calcium meal for better absorption
Correct answer: Take the medication with a full glass of water and remain upright for 30–60 minutes
Bisphosphonates must be taken with plain water and the patient must remain upright for 30–60 minutes to prevent severe esophageal ulceration.
Question 6: A patient receiving chemotherapy develops a platelet count of 18,000/mm³. Which nursing action is the HIGHEST priority?
- Encourage increased oral fluid intake
- Implement bleeding precautions and fall prevention measures (Correct answer)
- Administer acetaminophen for anticipated discomfort
- Obtain cultures to assess for infection
Correct answer: Implement bleeding precautions and fall prevention measures
A platelet count below 20,000/mm³ carries a high risk of spontaneous bleeding; implementing bleeding precautions (soft toothbrush, avoiding NSAIDs, fall prevention) is the immediate priority.
Next Next Pharmacology and Medication Management 2
A patient is allergic to penicillin.
Which antibiotic class requires the MOST caution due to cross-reactivity?