ATI RN
Pharmacology Assessment 2 ATI Capstone Questions
Question 1 of 5
The nurse is caring for a postoperative patient. The nurse will anticipate administering which medication to this patient to help prevent thrombus formation caused by slow venous blood flow?
Correct Answer: D
Rationale: Low-molecular-weight heparin is commonly administered to postoperative patients to help prevent thrombus formation caused by slow venous blood flow. This medication works by inhibiting the formation of blood clots. It is considered safer and more effective than unfractionated heparin in preventing venous thromboembolism in surgical patients. Aspirin and clopidogrel are antiplatelet medications that are more commonly used for preventing arterial thrombosis rather than venous thrombosis. Alteplase is a thrombolytic medication used to dissolve existing blood clots, rather than prevent their formation.
Question 2 of 5
The ophthalmologist asks the nurse to prepare to assist in the administration of tetracaine, fluorescein stain, and atropine for a diagnostic eye examination. Before assisting in the procedure, it is most important for the nurse to inform the ophthalmologist if the patient has a history of which condition?
Correct Answer: B
Rationale: Atropine is a mydriatic agent that dilates the pupil and can precipitate angle-closure glaucoma in patients with a narrow anterior chamber angle. Therefore, it is critical to inform the ophthalmologist if the patient has a history of angle-closure glaucoma. Cataracts (A), open-angle glaucoma (C), and macular degeneration (D) are not contraindications for the use of atropine.
Question 3 of 5
A patient's chart includes an order that reads as follows: 'Lanoxin 250 mcg once daily at 0900.' Which action by the nurse is correct?
Correct Answer: D
Rationale: Lanoxin (digoxin) is a medication commonly used to treat heart failure and arrhythmias. The order specifies the dosage and timing but does not indicate the route of administration. Since digoxin can be administered orally, intravenously, or intramuscularly, the nurse must clarify the route with the prescriber to ensure safe and accurate administration. Administering the medication via the wrong route could lead to serious complications, such as toxicity or ineffective treatment. Therefore, contacting the prescriber for clarification is the correct and safest action for the nurse to take.
Question 4 of 5
Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy?
Correct Answer: B
Rationale: Metformin (Glucophage) is a biguanide medication used to manage type 2 diabetes. While it is generally well-tolerated, one of its rare but serious adverse effects is lactic acidosis, a condition characterized by the buildup of lactic acid in the bloodstream. This can occur in patients with renal impairment or other risk factors. Hypoglycemia is uncommon with metformin alone, and GI distress, though common, is not life-threatening. Somnolence is not typically associated with metformin. Therefore, lactic acidosis is the most specific and serious adverse effect.
Question 5 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.