NR-293 Pharmacology for Nursing Practice - Set 3 - Part 2

Correct Answer: Inhale quickly and forcefully through the device

A dry powder device relies on the client's own inspiratory effort to lift powder from the chamber. A quick forceful deep breath is required, unlike the slow steady inhalation an aerosol canister needs. Option a is incorrect because shaking belongs to pressurized canisters that must mix propellant with drug. Powder devices are never shaken, and doing so can spill or unseat a loaded dose. Option b is incorrect because breath directed into the mouthpiece carries moisture that clumps the powder. Clients are taught to exhale away from the device and only then seal the lips. Option d is incorrect because a gentle drawn out breath suits an aerosol plume, not a powder that must be pulled free. Slow inhalation leaves most of the dose sitting in the device.

Correct Answer: "I will crush the capsule and stir it into hot soup."

Delayed release capsules carry an acid resistant coating that must survive the stomach intact. Crushing destroys it, and hot liquid compounds the problem, so the client would lose most of the intended effect. Option b is incorrect because swallowing the capsule whole with water is precisely the correct technique. That statement shows the client absorbed the teaching and needs no correction before going home. Option c is incorrect because stopping early when symptoms fade is the classic error, and this client plans to avoid it. Erosive tissue needs the full four to eight week course to heal. Option d is incorrect because checking before adding nonprescription products protects against interactions with antacids, iron, and other agents affected by gastric pH. That habit is exactly what discharge teaching aims to build.

Correct Answer: Withhold the drug and contact the prescriber

Failing kidneys cannot clear magnesium, so repeated doses build toward hypermagnesemia with lethargy, bradycardia, hypotension, and lost deep tendon reflexes. The nurse holds the drug and asks for a safer aluminum based product. Option a is incorrect because water improves how the suspension spreads but changes nothing about magnesium elimination. Administering the dose at all is the error here, and extra fluid cannot rescue damaged kidneys. Option c is incorrect because antacids belong with or shortly after food, when acid is present to neutralize. Refining the schedule sidesteps the real problem, which is magnesium accumulation in a client who cannot excrete it. Option d is incorrect because teaching about diarrhea accepts an order that should be questioned. Loose stools are the least of the dangers when serum magnesium climbs in someone with advanced renal disease.

Correct Answer: Switching to a combination aluminum and magnesium product

Aluminum salts bind phosphate and slow the bowel, so constipation is their signature effect. Combination products add magnesium, whose loosening action offsets the aluminum and keeps the bowel pattern closer to normal. Option b is incorrect because reaching for a second drug to treat the first drug's effect adds dependence risk without fixing anything. Stimulant agents also irritate the bowel and are poor choices for ongoing use. Option c is incorrect because more aluminum means more binding in the gut and firmer stools still. Raising the dose intensifies the very complaint the client brought to the nurse's attention. Option d is incorrect because sodium bicarbonate loads the client with sodium and provokes belching, distention, and metabolic alkalosis over time. It is a poor substitute and does not address the constipation at all.

Correct Answer: Hold the drug and obtain liver function tests

Propylthiouracil carries a boxed warning for severe liver injury and acute liver failure. Jaundice with dark urine and right upper quadrant discomfort fits hepatic damage, so the drug is held and hepatic enzymes are checked. Option a is incorrect because a differential hunts for agranulocytosis, which announces itself with sore throat, fever and mouth ulcers. None of those appear here, and a normal count would not explain the yellow sclera. Option b is incorrect because pushing water treats dehydration, not a damaged liver. Waiting seven days while hepatocytes continue to die can allow a reversible injury to progress into fulminant failure requiring transplant. Option d is incorrect because a fasting thyroid panel measures how well the gland is being suppressed. Those numbers say nothing about hepatic toxicity, and delaying food adds no diagnostic value to this presentation.

Correct Answer: Give a fast acting carbohydrate now

Symptoms of a falling glucose during the aspart peak demand treatment before anything else. A fast acting carbohydrate is given immediately, the glucose is rechecked in fifteen minutes, and the meal follows. Option a is incorrect because chasing the tray takes minutes the client does not have while glucose keeps dropping. The call belongs after symptoms have been treated at the bedside. Option b is incorrect because recording an event never substitutes for managing it. Charting happens once the client is stable, and a delay here allows neuroglycopenic signs such as confusion to appear. Option c is incorrect because withholding a future dose has no effect on the glucose falling at this moment. Dose adjustments belong to the provider once the acute episode resolves.

Correct Answer: Magnesium salts drawing water into stool

Magnesium containing antacids reliably loosen stools because the magnesium salt pulls water into the bowel. Frequent dosing magnifies the effect, and switching to a combination product with aluminum usually restores a normal pattern. Option a is incorrect because aluminum hydroxide binds phosphate and slows the bowel, so it produces constipation instead. Manufacturers pair it with magnesium precisely so the two opposite bowel effects cancel each other out. Option c is incorrect because rebound acidity from calcium carbonate shows up as worsening heartburn after the drug is stopped. This client has loose stools while still taking the product, which points elsewhere. Option d is incorrect because sodium bicarbonate causes belching, flatulence, and gastric distention, along with a sodium load that troubles clients with heart failure. Loose stools are not part of that picture.

Correct Answer: Cut back on coffee, cola, and chocolate

Caffeine is itself a methylxanthine, so it stacks onto theophylline and worsens tachycardia, tremor, and insomnia. Trimming coffee, cola, tea, and chocolate keeps those stimulant effects from becoming intolerable. Option a is incorrect because pairing the tablet with grapefruit juice adds nothing helpful and invites unpredictable handling by liver enzymes. Plain water is the beverage recommended with each scheduled theophylline dose. Option b is incorrect because chewing an extended release tablet dumps the whole amount at once and can push the serum level into the toxic range. These tablets are swallowed intact. Option d is incorrect because loading up on caffeine multiplies the stimulant burden without opening a single airway. Worsening breathing calls for the rescue inhaler and a call to the prescriber instead.

Correct Answer: Glucose tablets taken by mouth

Acarbose blocks the intestinal enzymes that split sucrose and lactose into absorbable glucose, so ordinary sugar sources act too slowly. Pure glucose in tablet or gel form is the treatment, and clients carry it. Option b is incorrect because juice supplies sucrose and fructose, which still require enzymatic breakdown that this drug blocks. The glucose would rise far too slowly for a symptomatic client. Option c is incorrect because milk sugar is lactose, a disaccharide that the blocked enzyme cannot split promptly. Its fat content slows gastric emptying further, delaying any useful effect. Option d is incorrect because table sugar is sucrose and depends on the very enzyme acarbose inhibits. Reaching for it wastes minutes while the sulfonylurea keeps pushing insulin from the pancreas.

Correct Answer: Stop the infusion immediately and assess the site

Promethazine is a vesicant that can cause severe tissue injury and gangrene when it escapes the vein. Burning during infusion is the warning sign, so the nurse halts the drug at once. Option a is incorrect because a slower rate still delivers a caustic drug into tissue that is already signalling injury. Continued infusion at any speed risks arterial spasm, necrosis, and eventual amputation. Option b is incorrect because heat is a comfort measure applied after the line is stopped and the provider has been notified. Warming an actively infusing vesicant spreads it through surrounding tissue. Option c is incorrect because analgesia masks the very pain that is warning the nurse about tissue damage. Elevation may help later, but nothing helps while the drug keeps entering the arm.

Correct Answer: Report the findings to the provider promptly

Thiazolidinediones carry a boxed warning for causing or worsening heart failure. Rapid weight gain, edema, and breathlessness are the reportable cluster, and therapy is reassessed rather than continued unchanged. Option a is incorrect because calling fluid overload expected ignores a boxed warning. Mild appetite related weight change differs entirely from several pounds in a week accompanied by dyspnea. Option b is incorrect because dietary sodium restriction alone leaves the drug driving the retention. The class is contraindicated in advanced heart failure, so a prescriber decision is needed here. Option d is incorrect because moving the time of day has no bearing on fluid retention from this drug. The glitazone effect builds over weeks and is unrelated to when the tablet is swallowed.

Correct Answer: Regular short acting insulin

Regular insulin is the only preparation routinely infused intravenously. Its molecules are unmodified and dissolve fully in solution, which allows the minute to minute titration that ketoacidosis management demands. Option a is incorrect because NPH is a protamine suspension, and suspensions must never enter a vein. Giving cloudy insulin intravenously risks an unpredictable and dangerous drop in blood glucose. Option b is incorrect because glargine is formulated at an acidic pH that precipitates in tissue for slow release. Intravenous use destroys that design and is never done. Option c is incorrect because a premixed product contains an intermediate cloudy component along with the rapid one. That cloudy portion rules out the vein just as plain NPH does.

Correct Answer: More drug reaches the lower airways

The chamber holds the aerosol so the client can inhale it over a couple of breaths. Less drug slams into the throat, more settles in the small airways, and thrush becomes less likely. Option b is incorrect because a metered dose inhaler still needs shaking before every actuation, spacer or not. The chamber changes how the aerosol is inhaled, never how the canister is prepared. Option c is incorrect because some steroid still lands on oral tissue even with a chamber attached. Rinsing and spitting remain part of the routine after every corticosteroid dose. Option d is incorrect because the metered amount released per actuation does not change. What improves is the share of that fixed dose arriving in the lung rather than the mouth.

Correct Answer: Bruising and bleeding gums when brushing

Cimetidine inhibits several cytochrome enzymes, so warfarin accumulates and the international normalised ratio climbs. Easy bruising and gum bleeding signal that anticoagulation has drifted into a dangerous range and needs prompt evaluation. Option a is incorrect because headache is a common and self limiting complaint with acid suppressing drugs. It carries none of the urgency of a bleeding sign in someone whose anticoagulant level may be rising. Option c is incorrect because a single loose stool is a nuisance effect worth monitoring, not reporting. Documenting the stool pattern and encouraging fluids covers it while the more serious interaction is ruled out. Option d is incorrect because altered taste turns up with many oral drugs and resolves once therapy ends. Nothing about it points toward the enzyme inhibition that makes this particular drug pairing risky.

Correct Answer: "I feel fine now so I can stop the pill"

Feeling well is proof the replacement is working, not a signal to quit. The thyroid gland cannot resume production, so therapy continues for life and symptoms would return within weeks of stopping. Option a is incorrect because daily uninterrupted dosing is precisely what the regimen requires. Skipped days let the hormone level drift downward, so this statement shows the client understood the teaching correctly. Option b is incorrect because sticking with one manufacturer keeps absorption consistent from bottle to bottle. Switching products can shift the thyroid stimulating hormone value, so brand loyalty here reflects sound understanding rather than error. Option d is incorrect because a fast resting pulse is one of the warning signs of excess hormone that providers want to hear about. Naming it demonstrates the client absorbed the safety instructions.

Correct Answer: These suggest lactic acidosis needing urgent evaluation

Malaise, myalgia, unusual somnolence, abdominal pain, and respiratory distress make up the subtle presentation of metformin associated lactic acidosis. The boxed warning reflects a fatal potential, so the client needs immediate assessment. Option a is incorrect because the usual early complaints are diarrhea, nausea, and a metallic taste, and they appear in the first weeks. Two years of therapy with new breathlessness fits a different picture. Option c is incorrect because dismissing this cluster as a virus delays laboratory testing for lactate and an anion gap. Reported cases have progressed to hypothermia, hypotension, and resistant bradyarrhythmias. Option d is incorrect because metformin does not stimulate insulin release and rarely causes low glucose when used alone. Sweating, tremor, and hunger would dominate if the sugar were actually falling.

Correct Answer: It replaces aldosterone and holds sodium and water

Addison disease destroys both hormone lines, so glucocorticoid alone leaves the salt-retaining half unreplaced. Fludrocortisone supplies mineralocorticoid activity, keeping sodium and water on board and pushing potassium out, which supports blood pressure and corrects the electrolyte pattern. Option b is incorrect because fludrocortisone has very little anti inflammatory power compared with the drugs chosen for arthritis. Hydrocortisone already covers that side, and joint disease is not part of this client's problem. Option c is incorrect because no steroid shields gastric mucosa and both of these drugs irritate it. Ulcer prevention comes from taking each dose with food and from avoiding anti inflammatory painkillers wherever possible. Option d is incorrect because one steroid does not speed elimination of another in this regimen. The two drugs work side by side on different receptors, and hydrocortisone keeps its usual short duration of action.

Correct Answer: The drug blocks new hormone from being made

Thionamides shut down synthesis of new thyroid hormone but leave the stored supply untouched. Symptoms fade only as that reservoir is used up, which is why relief takes several weeks rather than days. Option a is incorrect because glandular destruction describes radioactive iodine, which is absorbed by thyroid cells and ablates them over six to twelve weeks. Methimazole leaves the tissue itself completely intact. Option b is incorrect because no antithyroid agent can strip out hormone that is already packaged and waiting inside the gland. That stored pool is precisely what keeps the client symptomatic for weeks. Option c is incorrect because circulating hormone is not trapped anywhere by this medication. Propranolol blunts the peripheral effects of that circulating supply, and propylthiouracil slows conversion of one form to another, but neither describes methimazole.

Correct Answer: Inability to empty the bladder

Blocking muscarinic receptors relaxes the detrusor and tightens outflow, so a man with an enlarged prostate can stop voiding altogether. Acute retention is the complication that sends these clients to the emergency department. Option a is incorrect because anticholinergic activity slows intestinal motility and produces constipation instead. Loose frequent stools would suggest an entirely different problem, such as infection or a laxative effect. Option c is incorrect because secretions dry up under histamine one blockade rather than increasing. Dry mouth and dry eyes are the usual complaints, and tearing points toward cholinergic stimulation instead. Option d is incorrect because muscarinic blockade tends to raise heart rate, not lower it. Falls in older adults on this drug come from sedation and unsteadiness rather than from a slowed pulse.

Correct Answer: A client with poorly controlled hypertension

Pseudoephedrine constricts vessels throughout the body, not just in the nose, so blood pressure and heart rate climb. Someone whose pressure is already uncontrolled stands to lose the most from that effect. Option b is incorrect because seasonal allergy is the ordinary reason people reach for these products. Nothing about pollen sensitivity turns a sympathomimetic into a hazard requiring a call before the others. Option c is incorrect because an underactive thyroid that is treated and stable carries little added risk. The warning attaches to hyperthyroidism, where excess thyroid hormone already drives the heart faster. Option d is incorrect because intermittent tension headache does not interact with alpha stimulation in any dangerous way. Insomnia might bother this client, yet cardiovascular danger sits with the hypertensive one.