ATI RN
Pharmacology Assessment 2 ATI Capstone Questions
Question 1 of 5
Which patient problem is a priority for patients receiving epidermal growth factor receptor inhibitors?
Correct Answer: B
Rationale: Epidermal growth factor receptor (EGFR) inhibitors commonly cause skin-related side effects, such as rash, dryness, and paronychia (nail inflammation). These side effects can lead to tissue injury and discomfort, impacting the patient's quality of life. While bone marrow suppression and reduced platelet activity are concerns with other chemotherapies, they are less common with EGFR inhibitors. Alopecia is also less frequently associated with these drugs. The nurse should prioritize monitoring and managing skin-related side effects to prevent complications and ensure patient comfort.
Question 2 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 3 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 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
Aspirin:
Correct Answer: B
Rationale: Aspirin, or acetylsalicylic acid, is metabolized to salicylic acid and acetic acid, not acetone, making the hydrolysis statement false. At low doses, it follows first-order kinetics, where elimination rate is proportional to concentration, a true statement reflecting its predictable clearance under therapeutic levels. It's primarily conjugated in the liver (e.g., to salicyluric acid), but excreted mainly via urine, not bile, so that's false. Aspirin irreversibly inhibits cyclooxygenase (COX) by acetylating it, unlike reversible NSAIDs, making that option false. The correct answer highlights aspirin's pharmacokinetic behavior at low doses, critical for its use in analgesia or cardioprotection, where steady-state effects depend on consistent elimination, contrasting with zero-order kinetics at overdose levels.