PSA Emergency Prescribing 3

Question 1

A hemodynamically stable patient has atrial fibrillation with rapid ventricular response (HR 148 bpm) and preserved ejection fraction. Which drug is preferred for acute rate control?

Accepted Answer

Metoprolol 5mg IV over 2 minutes (may repeat x2)

Answer

IV beta-blockers such as metoprolol are first-line for rate control in AF with RVR in hemodynamically stable patients with preserved EF.

Question 2

A patient presents 2.5 hours after ischemic stroke onset with NIHSS 12 and BP 160/88 mmHg. There are no contraindications. What is the correct treatment and dose?

Accepted Answer

Alteplase (tPA) 0.9mg/kg IV (max 90mg), 10% as bolus then remainder over 60 min

Answer

Alteplase 0.9mg/kg IV (max 90mg) is the standard thrombolytic for eligible ischemic stroke within 4.5 hours of onset.

Question 3

A patient with Type 1 diabetes presents in DKA (glucose 520 mg/dL, pH 7.08, bicarbonate 8 mEq/L). What is the initial fluid resuscitation of choice?

Accepted Answer

0.9% Normal saline 1L IV over 1 hour

Answer

Isotonic normal saline is the initial fluid for DKA to correct volume deficit and hemodynamic instability before transitioning to 0.45% NaCl.

Question 4

An unconscious patient is found with pinpoint pupils and a respiratory rate of 4 breaths/min. What is the immediate treatment?

Accepted Answer

Naloxone 0.4–2mg IV/IM/intranasal

Answer

Naloxone is the specific opioid antagonist that rapidly reverses opioid-induced respiratory depression, miosis, and coma.

Question 5

A patient in cardiac arrest with ventricular fibrillation has received CPR and two defibrillation shocks without return of spontaneous circulation. What drug is indicated next?

Accepted Answer

Epinephrine 1mg IV every 3–5 minutes

Answer

Epinephrine 1mg IV every 3–5 minutes is the vasopressor of choice in cardiac arrest per current ACLS guidelines.

(PSA) Prescribing Safety Assessment Practice Test

(PSA) Prescribing Safety Assessment Practice Test

PSA Emergency Prescribing 3