NR-293 Pharmacology for Nursing Practice - Set 4 - Part 2

Correct Answer: A markedly elevated creatine kinase level

Muscle breakdown from sustained rigidity releases creatine kinase, and the level tracks severity. Myoglobin from the same process can obstruct the tubules, which is why aggressive fluid replacement protects the kidneys. Option a is incorrect because a falling sodium points toward the syndrome of inappropriate antidiuretic hormone seen with carbamazepine and some antidepressants. It does not arise from the muscle destruction driving this emergency. Option b is incorrect because clotting times belong to anticoagulant monitoring and liver failure workups. Nothing in the cardinal tetrad of fever, rigidity, altered awareness, and unstable vital signs turns on how quickly blood clots. Option c is incorrect because a collapsing neutrophil count is the clozapine problem, tracked with scheduled blood draws and reported fevers. Here the white count actually rises, often with a left shift.

Correct Answer: Hold the dose and clarify the washout interval

Fourteen days must separate a serotonin reuptake inhibitor from a monoamine oxidase inhibitor, and only four have passed. Holding the dose while the interval is clarified prevents a potentially fatal serotonin syndrome. Option a is incorrect because food changes tolerance of the drug, not the danger of overlapping serotonergic action. Nausea is a trivial concern beside an unsafe interval between two agents that must never coincide. Option b is incorrect because a baseline pressure is useful yet worthless as a safeguard here. Recording a number and then giving the drug still exposes the client to the interaction the washout exists to prevent. Option d is incorrect because dietary teaching is essential later but does nothing about the overlap problem tonight. Tyramine restriction guards against hypertensive crisis, a separate hazard from the serotonergic reaction being risked.

Correct Answer: Arrange provider review of renal function tests

Marked polyuria with dilute urine and unquenchable thirst suggests nephrogenic diabetes insipidus from long term lithium. Renal function and urinalysis need provider review, since the drug can also cause chronic interstitial changes. Option a is incorrect because slashing fluid intake in a client already losing free water invites dehydration and a climbing lithium level. The polyuria is renal in origin and will not stop when drinking stops. Option c is incorrect because loading extra salt shifts the level in an unpredictable direction and was never part of the teaching. Consistency, not supplementation, is what protects the client, and the kidney findings still need evaluation. Option d is incorrect because thirst and heavy urination are among the findings clients are specifically taught to report. Calling them harmless would let a treatable kidney effect progress unnoticed toward permanent damage.

Correct Answer: Assisting the client to rise slowly and walk

Helping a client change position slowly and steadying them during walking is routine care within the assistive role. Teaching, assessment and evaluation of the drug regimen stay with the licensed nurse. Option a is incorrect because explaining how alpha blockade drops standing pressure is client education, a nursing responsibility that cannot be handed off. Assistive personnel reinforce instructions but never deliver the original teaching. Option b is incorrect because judging whether a dose needs changing calls for clinical evaluation and provider collaboration. That reasoning sits well outside the training and legal scope of unlicensed staff. Option c is incorrect because gait assessment for fall risk is a nursing judgment that guides the plan of care. Aides may report what they observe, yet the appraisal itself remains the nurse's work.

Correct Answer: The client with fever and rigid limbs

Fever with generalised rigidity in a client on an antipsychotic points to neuroleptic malignant syndrome, which kills through hyperthermia and rhabdomyolysis. That client is seen first so the drug can be stopped. Option a is incorrect because oral movements of tardive dyskinesia develop over months and carry no immediate physiologic threat. This client does need prompt reporting and a regimen review, though not ahead of a hyperthermic emergency. Option b is incorrect because akathisia is miserable and deserves attention, yet restlessness does not destroy muscle or drive the temperature upward. Propranolol or a dose change can wait until the unstable client is seen. Option d is incorrect because dry mouth and constipation are anticholinergic nuisances common to this class. They warrant fluids, fibre, and a bowel plan, but they place no client at risk of dying within hours.

Correct Answer: Drug induced pseudoparkinsonism

Cogwheel rigidity, bradykinesia, a pill rolling tremor, and mask like facies appearing over weeks describe pseudoparkinsonism. Benztropine, trihexyphenidyl, or amantadine relieve it, and a dose reduction or drug switch is often added. Option b is incorrect because neuroleptic malignant syndrome brings high fever, lead pipe rigidity, altered consciousness, and unstable vital signs together. This client is afebrile and alert, so the emergency picture is absent. Option c is incorrect because the late syndrome produces involuntary chewing, puckering, and tongue protrusion after months or years. Six weeks is far too early, and a shuffling gait is not part of that movement pattern. Option d is incorrect because dystonia strikes in the first hours or days as a sudden sustained spasm of the neck, jaw, or eyes. Nothing here is sudden, and the findings built gradually over weeks.

Correct Answer: Plotting height and weight on a growth chart

Stimulants suppress appetite and can slow growth over time, so height and weight are plotted at every visit. Persistent slowing prompts reevaluation, and blood pressure and heart rate are checked alongside them. Option a is incorrect because gum overgrowth is a hydantoin problem seen with long term phenytoin, not with dopamine and norepinephrine reuptake blockers. Nothing in stimulant therapy drives that kind of tissue change. Option b is incorrect because vision testing has no bearing on stimulant safety. Routine eye checks belong to general pediatric care, while this drug demands attention to appetite, sleep, growth and cardiovascular measurements instead. Option c is incorrect because methylphenidate is titrated to symptom response rather than to a serum concentration. Antiepileptics such as phenytoin and valproate need levels drawn, yet stimulants have no established therapeutic window to target.

Correct Answer: Akathisia, which a dose increase would worsen

Inner restlessness with an irresistible urge to move, appearing within about four weeks, is akathisia. Raising the antipsychotic dose intensifies it, so the plan is dose reduction, a switch, or propranolol. Option a is incorrect because psychosis returns as hallucinations, delusions, and disorganised thought rather than as motor restlessness the client can describe himself. Adding more drug would only drive the restlessness higher. Option c is incorrect because tardive dyskinesia shows up after months or years as involuntary lip smacking and tongue movements. Benztropine actually makes those movements worse and has no place in this client's care. Option d is incorrect because primary anxiety would not have started in lockstep with a new antipsychotic. A benzodiazepine may blunt the discomfort, yet the driver is dopamine blockade and the regimen itself must change.

Correct Answer: Stopping suddenly brings dizziness, nausea and electric shock sensations

Paroxetine has a short half life, so abrupt withdrawal brings dizziness, nausea, chills, irritability, vivid dreams and brain zap sensations within days. The drug must travel with the client and be tapered only under guidance. Option b is incorrect because these antidepressants do not create dependence in the way controlled drugs do, so skipping doses buys nothing. Interrupted therapy instead invites both withdrawal symptoms and a return of depression. Option c is incorrect because raising the amount after a gap risks toxicity and does not undo the withdrawal already suffered. Steady daily dosing, not catch up dosing, keeps serum levels where they belong. Option d is incorrect because a fortnight without paroxetine reliably produces discontinuation symptoms, given its rapid clearance. Fluoxetine is the agent whose long half life cushions a missed stretch, and paroxetine is its opposite.

Correct Answer: Hold the dose and notify the provider

Cholinesterase inhibitors raise acetylcholine and can slow the heart to the point of syncope. A pulse this low meets hold parameters, so the nurse withholds the dose and tells the provider before the next one is due. Option a is incorrect because rechecking later does not undo a dose already swallowed. Donepezil will deepen the bradycardia over the coming hours, and an older adult who faints at night is at high risk of fracture. Option b is incorrect because fluid with the tablet addresses swallowing and stomach upset, both minor concerns next to a heart rate this slow. Administration technique cannot make an unsafe dose safe. Option d is incorrect because splitting a dose is prescribing, and nurses do not alter amounts on their own. Half a dose still adds cholinergic tone to a heart already beating too slowly for comfort.

Correct Answer: Hold the next dose and obtain a serum level

Nystagmus on lateral gaze and ataxia mark a phenytoin level above the therapeutic range of ten to twenty micrograms per milliliter. Holding the dose and drawing a level protects the client from worsening toxicity. Option a is incorrect because a walker manages the consequence while the drug level keeps climbing. Phenytoin follows nonlinear kinetics, so an untreated rise moves the client from ataxia toward slurred speech and lethargy. Option c is incorrect because these findings are toxicity rather than transient early side effects that fade. Reassurance delays the level draw, and the client leaves the clinic still taking a dose that is too high. Option d is incorrect because the eye movement is a central drug effect, not an ophthalmologic problem needing a specialist. Delaying a week leaves a toxic client unmonitored when a same day serum level answers the question.

Correct Answer: Stop the injection and call for help

Perioral tingling, metallic taste and tinnitus are the first signs of local anesthetic systemic toxicity, which moves on to twitching, seizures and cardiac collapse. Injection stops, oxygen goes on and help is summoned. Option a is incorrect because these sensations are warnings, not ordinary side effects of infiltration. Calling them normal lets the drug level keep climbing until seizures and arrhythmias appear, when lipid emulsion rescue becomes necessary. Option b is incorrect because cooling the skin treats a local reaction while the trouble is systemic. Anesthetic already in the bloodstream is reaching the central nervous system, and ice does nothing to lower that level. Option d is incorrect because comfort measures cannot substitute for stopping the source. Continuing the injection adds more drug to a client already showing early neurologic toxicity, which is how the progression to arrest begins.

Correct Answer: Two anticholinergic drugs are cancelling the donepezil effect

Oxybutynin and diphenhydramine block acetylcholine receptors, which directly opposes what donepezil is trying to achieve. The nurse reports the combination so the prescriber can substitute agents without anticholinergic activity. Option b is incorrect because these drugs do not simply stop working through tolerance. Loss of effect in this client traces to two other prescriptions on the list, and removing them can restore the response. Option c is incorrect because blaming progression forecloses a fixable drug problem. Alzheimer disease does advance despite treatment, yet an abrupt change in benefit alongside two new anticholinergic prescriptions points to interaction rather than decline. Option d is incorrect because donepezil is deliberately given at bedtime and absorption is not affected by the hour. Timing influences when nausea or vivid dreams appear, not how much acetylcholine survives in the synapse.

Correct Answer: Explain that bleeding risk rises with both drugs

NSAIDs add their own platelet inhibition and gastric injury to anticoagulation, so the pair produces bruising, gum bleeding and gastrointestinal hemorrhage. The client should call the provider before taking any over the counter analgesic. Option a is incorrect because the interaction pushes anticoagulation further, not backward. Naproxen displaces warfarin from protein binding sites and injures the gastric lining, which is why the international normalised ratio and bleeding both climb. Option b is incorrect because sedation is not a feature of either drug. Naproxen brings gastrointestinal and renal hazards while warfarin thins the blood, and neither one produces the drowsiness described in this option. Option c is incorrect because an analgesic cannot prevent clot formation in a fibrillating atrium. Stopping warfarin in favour of naproxen would leave the client unprotected against stroke while adding a fresh bleeding hazard.

Correct Answer: Black tarry stools and bleeding gums

Serotonin reuptake inhibitors deplete platelet serotonin, and combined with warfarin the bleeding risk climbs. Tarry stools with gum bleeding point to active gastrointestinal blood loss, which warrants prompt reporting and an international normalised ratio check. Option b is incorrect because queasiness is the most common early effect of this class and settles as tolerance develops. Timing the dose with food handles it, and no bleeding is implied by the complaint. Option c is incorrect because fluoxetine is activating, so broken sleep fits the expected profile. Moving the dose to the morning usually solves it, and insomnia never signals the anticoagulant interaction in question. Option d is incorrect because reduced saliva is a mild anticholinergic nuisance that comfort measures manage well. Sugarless candy and frequent sips keep the mouth moist, and nothing about it threatens hemostasis.

Correct Answer: Instruct her to hold lithium and obtain a level

Vomiting, diarrhea, and heat all strip sodium and water, and the kidney answers by reabsorbing more lithium. Holding the drug and drawing a stat level protects the client while the provider reviews the result. Option a is incorrect because cutting salt while sodium is already being lost pushes the lithium level higher still. Clients are taught to keep daily salt intake steady, never to restrict it during illness. Option b is incorrect because reassurance ignores a genuine emergency in the making. Three days of fluid loss in hot weather is exactly the setup for accumulation, and the client needs assessment rather than comfort. Option d is incorrect because ibuprofen belongs to the nonsteroidal group that reduces renal lithium clearance. Adding it to an already dehydrated client compounds the danger, and acetaminophen would be the safer choice here.

Correct Answer: Flumazenil given intravenously

Flumazenil is the competitive benzodiazepine receptor antagonist used for overdose. Because its duration is shorter than that of most benzodiazepines, the client is watched at least two hours for return of sedation. Option a is incorrect because naloxone reverses opioids at the mu receptor and leaves benzodiazepine binding untouched. Giving it here would waste time while respiratory depression from a different receptor system continues unopposed. Option b is incorrect because acetylcysteine belongs to acetaminophen poisoning, where it restores glutathione and protects the liver. Nothing about a sedating drug overdose responds to that mechanism, and the client would stay obtunded. Option c is incorrect because protamine sulfate neutralizes heparin and has no action in the central nervous system. Reaching for an anticoagulant reversal agent in this scenario would leave the sedation entirely unaddressed.

Correct Answer: "I will count the acetaminophen in my cold medicine."

Acetaminophen hides in many cold, flu and combination products, so every source counts toward the daily ceiling of four grams for a healthy adult. Reading labels for acetaminophen or APAP prevents accidental overdose. Option a is incorrect because doubling doses pushes the total past the safe ceiling and toward the toxic metabolite that destroys liver cells. Pain that is not controlled needs a new prescription, not a larger tablet count. Option c is incorrect because alcohol depletes the glutathione that neutralises the toxic metabolite. Regular drinking lowers the safe daily amount to about two grams and makes liver injury far more likely at ordinary doses. Option d is incorrect because tracking every dose matters most when the client feels well enough to reach for extra remedies. Improvement in pain does not raise the ceiling or protect the liver from stacked products.

Correct Answer: A pseudoephedrine decongestant tablet

Pseudoephedrine is a sympathomimetic, and with monoamine oxidase inhibited it can drive blood pressure into crisis. Over the counter cold products of this kind are prohibited for anyone taking these antidepressants. Option a is incorrect because saline moistens nasal membranes without any systemic absorption or vascular effect. It contains no sympathomimetic, so it stays on the safe list for clients on these agents. Option b is incorrect because a soothing lozenge coats the throat and carries no active pressor. Honey and menthol do not interact with monoamine oxidase inhibition, so the client may keep using it. Option d is incorrect because acetaminophen relieves aches through central pathways and leaves vascular tone alone. Meperidine and tramadol are the analgesics that must be avoided here, not this ordinary fever reducer.

Correct Answer: Slurred speech with an unsteady, staggering gait

Slurred speech and ataxia mark the moderate range of lithium toxicity, and fever with vomiting has almost certainly driven the level upward. The nurse holds the dose and reports these neurologic changes at once. Option b is incorrect because a metallic taste is a nuisance effect that shows up at ordinary therapeutic concentrations. It carries no neurologic weight and would not by itself justify holding a scheduled dose. Option c is incorrect because fine tremor accompanies lithium therapy from the start and often responds to propranolol. Only when the tremor becomes coarse and twitching appears does the picture shift toward accumulation. Option d is incorrect because polyuria is among the routine effects of lithium and can persist for years. It deserves documentation and attention to hydration, yet it lacks the urgency of a client who cannot speak clearly.