ATI RN
2019 ATI Pharmacology Proctored Exam Questions
Question 1 of 5
The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal <20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action?
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.
Question 2 of 5
A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
Correct Answer: B
Rationale: Topical corticosteroids can exacerbate viral infections, such as herpes simplex, by suppressing the immune response. They are contraindicated in the presence of viral infections to prevent worsening of the condition. Bacterial, parasitic, and spirochete infections are not absolute contraindications, although caution is advised.
Question 3 of 5
The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication?
Correct Answer: D
Rationale: In the scenario described, the patient presents with acute decompensated heart failure (HF) with dyspnea at rest, indicating severe symptoms. Nesiritide, a recombinant B-type natriuretic peptide, is commonly used in the management of acute decompensated HF to improve symptoms of dyspnea and congestion. It acts as a vasodilator and promotes natriuresis and diuresis, helping to alleviate the symptoms of heart failure exacerbation. While other medications like Carvedilol (Coreg) and Lisinopril (Prinivil) are commonly used in chronic HF management, in this acute scenario with severe symptoms, Nesiritide would be the appropriate medication to anticipate for administration in the ICU setting. Atropine is not indicated for acute decompensated heart failure.
Question 4 of 5
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
Correct Answer: D
Rationale: Lidocaine is a local anesthetic that can have systemic effects if levels become toxic. Continuous infusion of lidocaine can lead to lidocaine toxicity, which can manifest as adverse effects including convulsions, altered mental status, confusion, seizures, and cardiac arrhythmias. Monitoring for signs of lidocaine toxicity, such as convulsions, is crucial when a patient is receiving continuous lidocaine infusion. It is important for the nurse to closely monitor the patient's neurological status and vital signs to promptly recognize and manage any adverse effects.
Question 5 of 5
A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?
Correct Answer: D
Rationale: When a patient requires immediate treatment for atrial fibrillation with digoxin, the fastest way to achieve a therapeutic effect is through intravenous administration. Option D, Digoxin 1 mg IV push now; then 0.25 mg IV daily, is the most appropriate order in this scenario. Intravenous administration allows for rapid absorption and onset of action, making it the preferred route for urgent situations like atrial fibrillation. By giving an initial loading dose intravenously, followed by a lower maintenance dose IV daily or orally, the patient can quickly achieve therapeutic digoxin levels to help stabilize the heart rhythm. Option D provides the most rapid and effective way to manage new-onset atrial fibrillation with digoxin.