ATI RN
Pharmacology Assessment 2 ATI Capstone Questions
Question 1 of 5
The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask?
Correct Answer: D
Rationale: Oxymetazoline causes rebound congestion if used beyond 3-5 days. Asking 'How long have you been using the medication?' identifies misuse, the likely cause of worsening symptoms. Bottle age , temperature , and other medications are secondary. D targets the root issue, making it the best question.
Question 2 of 5
A 26-year-old woman presents to her primary care physician complaining of seasonal allergies. She has done well without medications for some time but now has worsening of her symptoms. She is given a prescription for fexofenadine. Which of the following adverse effects must be considered in this patient?
Correct Answer: B
Rationale: Fexofenadine for allergies may cause headache , a frequent side effect of this non-sedating antihistamine. Flank pain , otitis , infection , and tinnitus (E) are rare. Headache monitoring ensures safe symptom relief.
Question 3 of 5
Which of the following antipsychotic agents is considered to be the most potent and, thus, have the highest risk of extrapyramidal symptoms?
Correct Answer: B
Rationale: Fluphenazine, a high-potency first-generation antipsychotic, strongly blocks D2 receptors, requiring lower doses for efficacy but increasing EPS risk (e.g., dystonia, parkinsonism) due to intense dopamine antagonism in the nigrostriatal pathway. Thioridazine and chlorpromazine, low-potency first-generation drugs, have weaker D2 affinity, causing more sedation and anticholinergic effects than EPS. Quetiapine, a second-generation antipsychotic, has low D2 potency and minimal EPS. Clozapine avoids EPS with broad receptor activity. Fluphenazine's potency, measured by dose equivalence and clinical data, correlates with its elevated EPS risk, distinguishing it here.
Question 4 of 5
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 5 of 5
Fluvoxamine:
Correct Answer: D
Rationale: Fluvoxamine inhibits CYP450 enzymes. It is not an MAOI, has weak anticholinergic effects, and does not require weekly blood counts.