Saudi Prometric Nursing Pharmacology 2 — Questions and Answers
Question 1: What are the signs of gentamicin (aminoglycoside) toxicity that a nurse should monitor?
- Increased appetite
- Hearing loss (ototoxicity), tinnitus, dizziness, and elevated creatinine (nephrotoxicity) (Correct answer)
- Weight gain
- Improved kidney function
Correct answer: Hearing loss (ototoxicity), tinnitus, dizziness, and elevated creatinine (nephrotoxicity)
Aminoglycosides like gentamicin have two major toxic effects: ototoxicity (hearing loss, tinnitus, vertigo) and nephrotoxicity (rising creatinine/BUN, decreased urine output). Trough and peak levels must be monitored to maintain therapeutic range.
Question 2: What is the nursing consideration for administering insulin lispro (Humalog)?
- Give 1 hour before meals
- Give immediately before or within 15 minutes of eating due to its rapid onset of action (Correct answer)
- Give at bedtime only
- It can only be given intravenously
Correct answer: Give immediately before or within 15 minutes of eating due to its rapid onset of action
Insulin lispro is a rapid-acting insulin with onset in 15 minutes. It must be given immediately before eating (within 15 minutes) to match the postprandial glucose rise. Giving it too early without food risks hypoglycemia.
Question 3: What is the antidote for acetaminophen (paracetamol) overdose?
- Protamine sulfate
- N-acetylcysteine (NAC/Mucomyst) (Correct answer)
- Naloxone
- Activated charcoal only
Correct answer: N-acetylcysteine (NAC/Mucomyst)
N-acetylcysteine (NAC) is the antidote for acetaminophen overdose. It works by replenishing glutathione stores in the liver, which are depleted during acetaminophen metabolism. It is most effective when given within 8-10 hours of overdose.
Question 4: What patient education should be provided about NSAIDs like ibuprofen?
- Take on an empty stomach for faster absorption
- Take with food to reduce GI irritation, avoid in renal disease, report black tarry stools, and avoid concurrent aspirin use (Correct answer)
- NSAIDs have no side effects
- They can be used long-term without monitoring
Correct answer: Take with food to reduce GI irritation, avoid in renal disease, report black tarry stools, and avoid concurrent aspirin use
NSAID education: take with food (reduces GI ulceration risk), report GI bleeding signs (black stools), avoid in kidney disease (reduces renal blood flow), monitor blood pressure (can cause fluid retention), and avoid combining with other NSAIDs or anticoagulants.
Question 5: What is the nurse's responsibility regarding high-alert medications in Saudi hospitals?
- Treat them the same as other medications
- Follow additional safety measures including independent double verification, standardized concentrations, and special labeling (Correct answer)
- Only pharmacists handle high-alert medications
- High-alert medications don't require special protocols
Correct answer: Follow additional safety measures including independent double verification, standardized concentrations, and special labeling
High-alert medications (insulin, heparin, KCl, opioids, chemotherapy) require extra safeguards: independent double verification by two nurses, standardized concentrations, bright warning labels, separate storage, and clear policies. ISMP and Saudi CBAHI standards mandate these measures.
Question 6: What is the purpose of therapeutic drug monitoring (TDM)?
- To increase medication costs
- To measure drug levels in the blood to ensure they are within the therapeutic range — effective but not toxic (Correct answer)
- To test for drug allergies
- To determine which brand of drug to use
Correct answer: To measure drug levels in the blood to ensure they are within the therapeutic range — effective but not toxic
TDM measures drug blood levels (trough/peak) to ensure concentrations are therapeutic (effective) but not toxic. It is essential for drugs with narrow therapeutic windows like vancomycin, aminoglycosides, digoxin, lithium, and certain anticonvulsants.
Saudi Prometric Nursing Pharmacology 2
What are the signs of gentamicin (aminoglycoside) toxicity that a nurse should monitor?