Quiz · Hard
High-yield drug classes, side effects, antidotes and nursing considerations, plus dosage and IV drip calculations with the full working. For nursing and pharmacology students.
Metoprolol belongs to which drug class, and what should the nurse check before each dose?
ACE inhibitor; serum potassium
Beta blocker; apical heart rate and blood pressure
Calcium channel blocker; blood glucose
Loop diuretic; urine output
The -olol suffix marks a beta blocker. It slows the heart and lowers blood pressure, so doses are commonly held for bradycardia (often an apical pulse below 60) or hypotension, per the prescriber's parameters.
A client taking lisinopril develops a persistent dry cough. Which drug class is the usual alternative?
Angiotensin II receptor blocker (ARB), such as losartan
Another ACE inhibitor, such as enalapril
A beta-2 agonist inhaler
A cough suppressant added to the ACE inhibitor long term
ACE inhibitors (-pril) raise bradykinin levels, which causes cough. ARBs (-sartan) block the same system further downstream without raising bradykinin. Switching to another -pril would not help. Angioedema with any ACE inhibitor is an emergency.
Warfarin therapy is monitored with which lab test, and what reverses it?
aPTT; protamine sulfate
Platelet count; vitamin K
INR; protamine sulfate
INR; vitamin K
Warfarin blocks vitamin K-dependent clotting factors and is monitored by PT/INR. Unfractionated heparin is monitored with aPTT and reversed with protamine sulfate, the pairing people often mix up.
A client receiving IV morphine has a respiratory rate of 6/min and is hard to arouse. Which medication should the nurse anticipate giving?
Naloxone
Flumazenil
Atropine
Acetylcysteine
Naloxone is an opioid antagonist that reverses respiratory depression. Its effect can wear off before the opioid's, so keep monitoring. Flumazenil reverses benzodiazepines.
What is the antidote for acetaminophen overdose?
Acetylcysteine
Naloxone
Flumazenil
Digoxin immune fab
Acetylcysteine replenishes glutathione, which detoxifies the harmful acetaminophen metabolite and protects the liver. It works best when started within about 8 hours of ingestion.
A client taking digoxin and furosemide reports nausea, loss of appetite and seeing yellow-green halos around lights. Potassium is 3.1 mEq/L. What is the most likely problem?
An allergic reaction to furosemide
Digoxin toxicity, made more likely by hypokalemia
Hyperkalemia from digoxin
Expected side effects that need no action
GI symptoms, visual changes and dysrhythmias are classic signs of digoxin toxicity. Low potassium (common with loop diuretics) increases digoxin's effect on the heart. Hold the dose, check the digoxin level and notify the provider.
A client starting spironolactone should be taught to avoid which product?
Salt substitutes that contain potassium chloride
Foods high in vitamin K
Grapefruit juice in all cases
Calcium-rich dairy products
Spironolactone is a potassium-sparing diuretic, so potassium can build up to dangerous levels. Salt substitutes are often potassium chloride. Vitamin K foods matter for warfarin instead.
Which findings should the nurse report for a client receiving gentamicin?
Orange-colored urine
Ringing in the ears and a rising serum creatinine
A dry cough
Increased appetite
Aminoglycosides are ototoxic and nephrotoxic. Tinnitus or hearing loss and worsening kidney function call for attention, and peak and trough levels guide dosing. Orange urine is a harmless effect of rifampin.
A client taking ciprofloxacin reports sudden pain in the back of the heel. What should the nurse suspect?
An expected reaction that resolves with exercise
Gout caused by the antibiotic
A sign that the infection is spreading to the foot
Tendon inflammation or rupture, a fluoroquinolone adverse effect
Fluoroquinolones carry a boxed warning for tendinitis and tendon rupture, most often of the Achilles tendon. The risk is higher in older adults and with corticosteroids. The client should rest the leg, and the drug is usually stopped.
Why must a client wait between stopping an MAOI (such as phenelzine) and starting an SSRI (such as sertraline)?
SSRIs are less effective after MAOIs
The combination causes severe hypoglycemia
Taking them too close together can cause serotonin syndrome
MAOIs block the absorption of SSRIs
Both raise serotonin, and together they can cause agitation, hyperthermia, tremor, muscle rigidity and autonomic instability. A washout of about 2 weeks is typical (longer, about 5 weeks, when switching from fluoxetine to an MAOI).
Which teaching point is most important for a client taking lithium?
Restrict sodium as much as possible
Keep a consistent fluid and sodium intake and report vomiting, diarrhea or heavy sweating
Take extra doses when feeling low
Blood levels are not needed once the dose is stable
Lithium has a narrow therapeutic range, and the kidneys handle it like sodium. Dehydration or low sodium raises lithium levels toward toxicity (coarse tremor, vomiting, confusion). Regular blood levels are required.
Why is metformin often held around a procedure using iodinated contrast dye?
Metformin makes the contrast less visible
Metformin causes an allergic reaction to contrast
Contrast can impair kidney function, and metformin buildup can cause lactic acidosis
Contrast raises blood glucose dangerously
Metformin is cleared by the kidneys. If contrast causes acute kidney injury, metformin accumulates and can trigger lactic acidosis. It is typically resumed about 48 hours later once kidney function is confirmed stable, following facility protocol.
The provider orders amoxicillin 500 mg PO. The suspension on hand is 250 mg/5 mL. How many mL should the nurse give?
10 mL
2.5 mL
5 mL
20 mL
. Sanity check: you need twice the 250 mg dose, so twice the 5 mL.
A child weighs 44 lb. The order is 15 mg/kg of a drug. What dose should the child receive?
660 mg
150 mg
30 mg
300 mg
Convert to kilograms first: . Dose = . 660 mg skips the conversion and multiplies by pounds, which overdoses the child.
1,000 mL of normal saline is to infuse over 8 hours with tubing that delivers 15 gtt/mL. What is the drip rate?
125 gtt/min
31 gtt/min
8 gtt/min
63 gtt/min
, which rounds to 31 gtt/min. 125 is the rate in mL/h, which is what you would set on an infusion pump.
