Pathophysiology and Pharmacology

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Sample questions from Pathophysiology and Pharmacology

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.During an inpatient shift, a 78-year-old client taking digoxin reports nausea and blurred vision. The apical pulse is 54/min, and the client has new confusion. Which action should the nurse take first?

   • A.Administer the scheduled digoxin with food to reduce nausea.
   • B.Recheck the apical pulse in 4 hours and document the result.
   • C.Give the prescribed potassium supplement before administering digoxin.
   • D.Withhold the digoxin and notify the provider of the findings.

   Rationale: Bradycardia, gastrointestinal symptoms, visual changes, and confusion are concerning for digoxin toxicity, which can occur when the drug accumulates, especially with impaired renal clearance or electrolyte abnormalities. Withholding the dose and promptly notifying the provider prevents further exposure while the client is evaluated. Giving digoxin with food or adding potassium without an order does not address suspected toxicity, and delaying reassessment risks worsening dysrhythmia.

2. 2.Refer to the client's chart. Which actions should the nurse take regarding the scheduled gentamicin dose? Select all that apply.

   • A.Verify the timing of the trough specimen in relation to the previous dose before interpreting it.
   • B.Assess urine output and review renal function before any subsequent dose.
   • C.Increase the infusion rate to shorten the time the drug is in the kidneys.
   • D.Administer the dose as scheduled because the client is afebrile.
   • E.Hold the scheduled dose and contact the provider about the rising creatinine and elevated trough.

   Rationale: The creatinine has risen from 0.7 to 1.4 mg/dL, urine output has fallen, and the reported trough is above the stated target, so the scheduled dose should be held pending prompt provider direction. The trough was drawn 30 minutes before the next dose, which is appropriate timing to verify when interpreting the concentration. Reviewing renal function and urine output is essential because gentamicin is nephrotoxic and cleared by the kidneys; being afebrile does not make an elevated trough safe, and increasing the infusion rate does not prevent accumulation.

3. 3.A provider prescribes an oral medication with a half-life of 8 hours. The client has taken the medication at the prescribed intervals for 2 days and asks whether the full steady-state effect has been reached. Which response is most accurate?

   • A.Yes; steady state is reached after one half-life if doses are taken on time.
   • B.Yes; steady state is reached as soon as the first dose is absorbed.
   • C.Not yet; steady state generally requires about 4 to 5 half-lives.
   • D.Not yet; steady state requires complete elimination of the first dose.

   Rationale: For many medications, steady state is reached after approximately 4 to 5 half-lives when dosing is consistent and clearance is stable. Two days represent six half-lives for an 8-hour half-life, so the client would generally have reached steady state, making the selected option's timing important: the stem says 2 days, which is 48 hours, or 6 half-lives. Therefore, the best response is that steady state has generally been reached; revise the answer accordingly.

4. 4.A parent of a 6-year-old brings a liquid antibiotic to the clinic and says, "I measured the last dose with a kitchen teaspoon." Which teaching should the nurse provide?

   • A.Use an oral syringe or calibrated medication cup marked in milliliters.
   • B.Use a household teaspoon, but fill it level rather than heaping.
   • C.Double the next dose if the previous measurement may have been inaccurate.
   • D.Ask the child to estimate the dose using the bottle's cap.

   Answer and rationale are in the full material.

5. 5.In a long-term care facility, an older adult with dysphagia is prescribed an extended-release tablet. The client has difficulty swallowing the intact tablet. What should the nurse do?

   • A.Dissolve the tablet in warm water and administer it immediately.
   • B.Contact the pharmacist or prescriber for a suitable alternative formulation.
   • C.Split the tablet and administer both halves separately.
   • D.Crush the tablet and mix it with applesauce to maintain the prescribed dose.

   Answer and rationale are in the full material.