ATI RN
Pharmacology Assessment 2 ATI Capstone Questions
Question 1 of 9
A 57-year-old man with a history of intermittent angina normally takes sublingual nitroglycerin when attacks occur. He states that he does not take this medication because it makes him feel 'funny... itch uncontrollably... and have pain radiating to his toes.' These symptoms have never been witnessed by his family members who are with him all the time. What is the best course of action for the treating physician to take?
Correct Answer: C
Rationale: Unusual nitroglycerin reactions (itching, toe pain) unwitnessed by family suggest noncompliance or psychogenic issues. Encourage use and explore reasons . Psychiatric or behavioral consults are premature. Switching or antipsychotics (E) ignores clarification. This approach ensures proper angina management.
Question 2 of 9
What is the category class of Valproate?
Correct Answer: C
Rationale: Valproate belongs to the category class of anticonvulsants, which means it is primarily used to treat seizures and epilepsy. Additionally, valproate also has properties that make it effective in the treatment of vascular headaches, such as migraines. It is not an anticoagulant, antianxiety medication like benzodiazepines, or a mood stabilizer.
Question 3 of 9
A 60-year-old epileptic woman who has been on the same dose of phenytoin for 20 years develops cerebellar ataxia with nystagmus. Her other medication consists of folic acid, hormone replacement therapy (HRT) and furosemide prescribed by the GP for ankle swelling and mild hypertension. She is referred to A&E. Routine investigations reveal an elevated plasma creatinine, normal plasma potassium and calcium, hypoalbuminaemia and proteinuria. The phenytoin concentration is 15 mg/L (therapeutic reference range 10-20 mg/L). A diagnosis of nephrotic syndrome is made and the cerebellar signs are attributed to phenytoin toxicity. Which of the following is likely to be correct?
Correct Answer: D
Rationale: Phenytoin toxicity (ataxia, nystagmus) occurs despite a ‘normal' total plasma level (15 mg/L) due to nephrotic syndrome's hypoalbuminemia. Normally, phenytoin is 90% protein-bound, with 10% free (active). Low albumin increases the free fraction (e.g., to 20%), raising CNS exposure despite a therapeutic total level. Creatinine doesn't typically interfere with phenytoin assays; they're reliable unless specific lab issues exist. Furosemide doesn't alter the blood-brain barrier for phenytoin; no evidence supports this. Oestrogen in HRT doesn't directly enhance phenytoin's CNS toxicity; it may affect metabolism, but not here. Cerebrovascular events don't fit the drug-related context. The increased free fraction explains toxicity, necessitating free level monitoring in hypoalbuminemia.
Question 4 of 9
A 71-year-old man who has chronic back pain after falling from a first-floor apartment 25 years ago is managed with a morphine pump for his chronic pain. He also had a long history of chronic diarrhea that preceded his accident. The pump has been in place for 22 years. Which of the following effects will still likely be maintained by the device at this time?
Correct Answer: B
Rationale: Long-term morphine via pump sustains certain effects. Constipation persists-tolerance doesn't fully develop to GI μ-receptor effects, unlike analgesia , euphoria , or sedation (E). Pupil dilation is incorrect; morphine causes miosis. After 22 years, constipation remains a chronic issue, reflecting opioid pharmacology.
Question 5 of 9
The nurse notes in the patient™s medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?
Correct Answer: C
Rationale: The primary goal of anticoagulant therapy is to prevent the formation of blood clots or thrombus. Anticoagulants work by inhibiting the coagulation cascade, which ultimately prevents the blood from clotting too easily. By preventing the formation of clots, anticoagulant therapy helps reduce the risk of conditions such as deep vein thrombosis, pulmonary embolism, stroke, and heart attack, which are all associated with blood clot formation. Anticoagulant therapy does not stabilize or dissolve existing clots but rather focuses on preventing new clots from forming. Dilating the vessel around a clot is not the primary purpose of anticoagulant therapy.
Question 6 of 9
The following drugs cause their primary pharmacodynamic effect via non-receptor mediated mechanisms:
Correct Answer: B
Rationale: Mannitol works osmotically, increasing urine flow without binding to receptors. Others rely on receptor or enzyme-based actions.
Question 7 of 9
Which of the following adverse effects is specific to the biguanide diabetic drug metformin
Correct Answer: C
Rationale: Lactic acidosis is an adverse effect specific to the biguanide diabetic drug metformin. It is a rare but serious complication associated with the use of metformin. Lactic acidosis occurs when there is a buildup of lactate in the body, leading to a decrease in pH levels. This condition can be life-threatening and requires immediate medical attention. Symptoms of lactic acidosis include rapid breathing, muscle pain or weakness, abdominal pain, dizziness, and irregular heartbeat. It is important for individuals taking metformin to be aware of the signs and symptoms of lactic acidosis and seek medical help if they experience them.
Question 8 of 9
The patient is admitted to the hospital in chronic renal failure and is on several medications. What best describes the nurse's assessment of this patient?
Correct Answer: C
Rationale: Chronic renal failure impairs kidney excretion, critical for drugs cleared renally-like metformin-raising toxicity risk if doses aren't adjusted, a targeted concern. Liver compensation aids metabolism, not excretion, so effectiveness isn't assured. Toxicity from all drugs assumes universal renal clearance, too broad. Decreased effectiveness ignores accumulation risks. Assessing for renal-excreted drugs' toxicity aligns with kidney function's role, ensuring safety by checking specific drug profiles.
Question 9 of 9
A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication?
Correct Answer: D
Rationale: Scheduled surgery would be a contraindication for taking garlic tablets because garlic has blood-thinning properties that could potentially increase the risk of bleeding during or after surgery. This can interfere with the blood's ability to clot properly, leading to excessive bleeding and other complications during the surgical procedure. It is important to inform healthcare providers about all supplements being taken, including garlic tablets, before undergoing any surgery to ensure patient safety.