NR-293 Pharmacology for Nursing Practice - Set 5 - Part 2

Correct Answer: New vertigo and a rising serum creatinine

Vancomycin, gentamicin and a loop diuretic together multiply damage to the kidney and the eighth cranial nerve. Vertigo with a climbing creatinine shows both target organs failing and calls for an immediate change. Option a is incorrect because nausea and an odd taste are common, tolerable complaints during many anti infective courses. Neither points toward the renal or vestibular injury that this drug combination threatens. Option b is incorrect because warmth and redness along the vein describe phlebitis, a local irritation handled by restarting the line in a new site. The nurse manages it without waking the provider. Option c is incorrect because loose stools with a fair appetite suggest ordinary bowel upset rather than organ toxicity. Bloody or watery diarrhea with fever would raise a different concern altogether.

Correct Answer: Finish every dose to prevent resistant survivors

Hardier organisms survive the early days of therapy, and stopping once symptoms fade lets those selected survivors repopulate. Taking every dose at evenly spaced intervals through the full course clears them and limits resistance. Option a is incorrect because saved antibiotics invite self treatment of a later illness that may be viral or caused by a different organism. Sharing or hoarding leftover doses is one of the behaviours that breeds resistance. Option b is incorrect because symptom relief arrives within roughly two days while bacteria remain alive in the tissue. Quitting there is exactly the behaviour the teaching aims to prevent, not the message to reinforce. Option d is incorrect because doubling up after a missed dose raises peak levels and adverse effects without improving cure. The rule is to take the forgotten dose unless the next one is nearly due.

Correct Answer: Begin at least a month before conception

The neural tube closes about four weeks after conception, often before a pregnancy is recognized. Starting folic acid a month or more ahead means adequate stores are present during the window when the defect is prevented. Option a is incorrect because a first prenatal visit usually happens near the end of the second month. By then the spinal column has already formed, so supplementation started at that appointment cannot prevent spina bifida. Option c is incorrect because waiting until the second trimester misses the critical period entirely. Folate still supports red cell production and fetal growth later in pregnancy, yet the neural tube question is settled long before then. Option d is incorrect because a positive test typically comes several weeks after conception, once closure has occurred. Half of pregnancies are unplanned, which is why daily supplementation is advised for anyone who could become pregnant.

Correct Answer: Normal saline, an isotonic solution

Normal saline matches plasma osmolality closely and contains no calcium or glucose, so red cells neither swell nor clump. It is the only fluid hung with blood products for that reason. Option a is incorrect because Ringer solution carries calcium, which can bind the citrate anticoagulant in the bag and let clots form in the tubing. Its isotonicity does not make it safe alongside blood. Option b is incorrect because a hypotonic fluid drives water across the red cell membrane. The cells swell and rupture, so hemolysis destroys the very product the client was ordered to receive. Option c is incorrect because dextrose in water behaves as free water once the sugar is metabolized. Glucose also causes red cells to clump, which is why this solution never shares a line with a transfusion.

Correct Answer: The antibiotic raises the risk of bleeding

Clarithromycin strongly inhibits the liver enzyme that clears warfarin, so anticoagulant levels climb and the international normalised ratio rises. Extra monitoring catches that drift before bruising or serious bleeding appears. Option a is incorrect because the direction of the interaction runs the other way. Enzyme inhibition slows warfarin breakdown, so the drug accumulates rather than fading, and clotting time lengthens instead of shortening. Option b is incorrect because no routine blood test tracks whether a chest infection is resolving. Clinicians follow symptoms, temperature, and breath sounds for that, while this particular draw watches the anticoagulant. Option d is incorrect because marrow suppression is not a macrolide problem. Hematologic injury of that kind belongs to sulfonamides, and nothing in this pairing threatens the red cell count over a short course.

Correct Answer: Measure and record the client's urine output

Measuring and recording output is a routine task within the assistive personnel's training, and the nurse still interprets the trend. Falling output on an aminoglycoside is the early sign of renal accumulation. Option b is incorrect because screening for tinnitus is an assessment, and assessment stays with the licensed nurse. Assistive personnel may report what a client says to them but cannot judge its meaning. Option c is incorrect because reading a serum level against a therapeutic range demands clinical judgment and a decision about the next dose. That responsibility sits squarely with the registered nurse and provider. Option d is incorrect because client teaching requires evaluating what the person already knows and confirming the message landed. Unlicensed staff may reinforce a point the nurse taught, yet the teaching itself is not theirs.

Correct Answer: Orange red urine that stains fabric

Phenazopyridine is a dye that turns urine a bright orange red. The stain sets into underclothing and soft contact lenses, so the client wears a pad, uses glasses and expects the color to fade after the drug stops. Option a is incorrect because a metallic taste is the calling card of metronidazole rather than this urinary analgesic. Phenazopyridine acts on the bladder lining and leaves taste untouched. Option c is incorrect because trouble seeing color belongs to ethambutol, whose optic neuritis must be reported at once. The dye in this drug colors fluids, not the client's vision. Option d is incorrect because cloudiness and foul odor point to the infection itself or to a worsening one. Those findings prompt a call to the provider and are not caused by the analgesic.

Correct Answer: Missing inflammatory signs reflect the low neutrophils

Pus, infiltrates and redness are built from neutrophils, so a client without them cannot produce those signs. Fever may be the only clue to serious infection and warrants full workup rather than reassurance. Option a is incorrect because reading a quiet examination as reassurance inverts the actual risk. The very absence of inflammation in a client with no neutrophils argues for infection, not against it. Option b is incorrect because tumor fever is a diagnosis of exclusion made only after infection has been ruled out with cultures and imaging. Assuming it here would delay antibiotics in a client at extreme risk. Option c is incorrect because no source can be excluded when the client lacks the cells that create visible signs. Blood cultures from every lumen and a broad search remain necessary despite the unremarkable examination.

Correct Answer: The elevated potassium and cardiac rhythm changes

Hyperkalemia from lysed tumor cells is the most immediately lethal part of tumor lysis syndrome because it triggers fatal arrhythmias. Continuous cardiac monitoring and potassium lowering measures come before the other abnormalities. Option b is incorrect because uric acid crystals injure the kidneys over hours to days, and hydration with rasburicase or allopurinol addresses that. Renal injury is serious yet slower than a lethal rhythm. Option c is incorrect because low calcium here follows phosphate binding it up, and cramps or tetany are treated after the rhythm is secured. Correcting calcium too early can worsen crystal deposition. Option d is incorrect because phosphate release is expected when phosphate rich tumor cells rupture, and mild nausea is common with any regimen. Neither element threatens the heart the way potassium does.

Correct Answer: Await central access confirmed by radiograph

Concentrated parenteral nutrition has an osmolarity far above what a small vein tolerates, so a central catheter with a radiograph confirmed tip is required. The rich dextrose also demands strict sterile line care. Option a is incorrect because a slow rate does not soften a hyperosmolar solution. Peripheral veins react with phlebitis, pain and thrombosis within hours, and the vessel is lost long before nutritional goals are met. Option b is incorrect because nurses never alter a compounded nutrition admixture. Adding anything breaks sterility, upsets the calculated balance of nutrients, and creates an infection risk in a solution that already feeds bacteria well. Option d is incorrect because bags are brought to room temperature by sitting out, never heated. Warming degrades the lipid emulsion and vitamins, and temperature was never the barrier to using this line anyway.

Correct Answer: Send the client for immediate evaluation and antibiotics

Fever in a neutropenic client is an oncologic emergency. Cultures are drawn and broad spectrum intravenous antibiotics must start within one hour, because an absolute neutrophil count this low allows bacteremia to progress within hours. Option a is incorrect because antipyretics at home mask the one warning sign this client can still produce. Delay of even a few hours in profound neutropenia lets a bloodstream infection turn septic. Option c is incorrect because waiting overnight treats this call as routine when the neutrophil count places the client hours from septic shock. A client with fever after chemotherapy needs antibiotics started the same hour. Option d is incorrect because rechecking a temperature later adds nothing when the reading already meets the definition of febrile neutropenia. Extra fluids do not touch the bacteremia that this fever most likely represents.

Correct Answer: Keep leafy green intake steady week to week

Warfarin works by opposing vitamin K, so the dose is set against the client's usual intake. Steady consumption keeps the international normalized ratio predictable, while swings in either direction push it too high or too low. Option a is incorrect because cutting greens out completely lowers vitamin K sharply and lets warfarin run stronger than intended. Bleeding risk climbs, and the client also loses folate, fiber and other nutrients those foods supply. Option b is incorrect because a sudden jump in vitamin K blunts the drug and lets clots form. Doubling servings would drag the international normalized ratio below range and defeat the reason warfarin was prescribed. Option d is incorrect because supplemental vitamin K is the antidote for warfarin, not a dietary companion to it. Taking it alongside therapy reverses the anticoagulation the client needs and belongs only under provider direction.

Correct Answer: Give intramuscular epinephrine without delay

Epinephrine reverses the airway swelling and vasodilation that kill in anaphylaxis, and it is the first drug given. Calling for help, positioning, oxygen and intravenous access all follow that injection. Option b is incorrect because an antihistamine relieves itching and hives but has no effect on bronchospasm or collapsing blood pressure. Choosing it first is a classic and sometimes fatal substitution. Option c is incorrect because positioning supports perfusion yet buys only seconds while the airway continues to close. Supine placement with the legs raised belongs in the sequence immediately after the epinephrine is in. Option d is incorrect because oxygen treats the consequence while the mediator storm continues unchecked. Delivering it before the injection wastes the narrow window in which epinephrine can still open a swelling airway.

Correct Answer: Give the dose through a straw, then rinse

Liquid iron stains dental enamel on contact. Diluting the dose, delivering it through a straw past the front teeth, and rinsing the mouth afterward keeps the pigment off the enamel while the full dose is still swallowed. Option a is incorrect because mixing iron into cereal surrounds it with phytates and often milk, both of which cut absorption sharply. The child also may not finish the bowl, leaving the actual dose unknown. Option b is incorrect because holding the preparation in the mouth is exactly what stains teeth. Prolonged contact with enamel produces the dark discoloration parents later complain about, and it offers no benefit for absorption. Option c is incorrect because undiluted liquid from a spoon washes over the teeth at full strength. Dilution in water or juice reduces both staining and gastric irritation, so serving it straight defeats the point.

Correct Answer: A falling hemoglobin and hematocrit value

Red cells have the longest lifespan, so anemia appears late in the myelosuppression sequence and shows itself as fatigue, pallor, dyspnea and dizziness. Falling hemoglobin and hematocrit confirm the picture. Option a is incorrect because hyponatremia produces confusion, headache and seizures rather than pallor and exertional breathlessness. Sodium loss belongs with high dose cyclophosphamide and its syndrome of inappropriate antidiuretic hormone. Option b is incorrect because chemotherapy drives white cells down, not up. A rising count during a cycle would suggest infection or a marrow response to growth factor, neither of which explains this fatigue. Option d is incorrect because a high potassium points toward tumor lysis syndrome, which brings arrhythmias and muscle weakness within days of the first dose. Pallor and dyspnea are not part of that picture.

Correct Answer: Loss of appetite with yellowed sclerae

Anorexia with jaundice signals drug induced hepatitis, the serious toxicity shared by isoniazid, rifampin and pyrazinamide. The client needs liver studies and the drugs held before the injury advances any further. Option b is incorrect because rifampin colors every body fluid orange red, and the client was warned to expect it. This harmless change stains soft contact lenses but never signals organ damage. Option c is incorrect because isoniazid blocks the breakdown of tyramine and histamine, so aged cheese can bring on flushing and headache. Avoiding those foods settles the problem without an urgent visit. Option d is incorrect because occasional heartburn that an antacid relieves is a nuisance rather than a warning of liver injury. The nurse can address timing and food at the next routine visit.

Correct Answer: Seven to fourteen days after treatment

The nadir, the lowest point of the blood counts, falls roughly one to two weeks after most myelosuppressive drugs. Counts drawn then capture the deepest neutropenia and thrombocytopenia, guiding precautions and the next cycle. Option a is incorrect because circulating neutrophils have not yet died off this early, so counts still look deceptively normal. Sampling now would miss the true low point and falsely reassure the team. Option c is incorrect because marrow recovery is usually complete in three to four weeks, which is why cycles are spaced that way. Waiting two months would sample a rebuilt marrow instead of a suppressed one. Option d is incorrect because sampling within hours reflects the counts the client already had before the drug acted. Myelosuppression develops as existing cells age out and replacement is blocked, a process measured in days.

Correct Answer: Keep the client seated for fifteen minutes

Syncope is common in adolescents right after vaccination, so the client stays seated or lying down for a quarter hour where staff can watch and prevent a fall injury. Option a is incorrect because sending a teenager off alone is exactly how post vaccination fainting turns into a head injury. The observation period exists for that risk, brief as it is. Option b is incorrect because rubbing an intramuscular site adds soreness and does nothing for absorption or immune response. Nothing in vaccine administration calls for massage after the needle comes out. Option c is incorrect because antihistamines are not given prophylactically and would not stop anaphylaxis if it occurred. Epinephrine is the drug kept ready at every vaccination site for that emergency.

Correct Answer: "I will take each capsule with food or milk."

Nitrofurantoin is one of the few antibacterials whose absorption improves with food, and taking it with a meal or milk also eases stomach upset. The full course is finished as prescribed. Option b is incorrect because a brown or dark yellow tint is a harmless effect of the drug leaving the body in the urine. Clients are warned ahead of time so it causes no alarm. Option c is incorrect because nitrofurantoin concentrates in urine and never reaches useful levels in blood or kidney tissue. Pyelonephritis and systemic infection require a drug that circulates, which this one does not. Option d is incorrect because an empty stomach reduces how much of this drug is absorbed and worsens the nausea it often causes. Food and milk improve both absorption and tolerance.

Correct Answer: "The reaction comes from the infusion rate, not an allergy."

The redness follows direct histamine release when vancomycin runs in too fast, so it is an infusion rate reaction. Slowing the rate and diluting the dose prevents it from happening again. Option a is incorrect because vancomycin carries no beta lactam ring and shares no cross sensitivity with penicillin. Testing for that allergy answers a question the client's flushing never raised. Option b is incorrect because the drug is nearly always restarted at a slower rate after an antihistamine. Treating a rate reaction as a permanent barrier costs the client the standard therapy for resistant staphylococcus. Option d is incorrect because epinephrine reverses airway swelling and shock in anaphylaxis, and this client has neither. Diphenhydramine plus a slower rate is what the reaction actually calls for.