ATI RN Pharmacology Proctored Test B Study Guide

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Sample questions from ATI RN Pharmacology Proctored Test B Study Guide

This material has 24 questions with answers and rationales. Here are the first 5.

1. 1.An older adult receiving gentamicin for a serious infection has a serum creatinine increase from 0.8 mg/dL to 1.7 mg/dL over 48 hours. Which action should the nurse take before administering the next dose?

   • A.Administer the dose because gentamicin is primarily eliminated by the liver.
   • B.Withhold the dose and contact the provider to review renal function and drug levels.
   • C.Administer the dose with food to reduce systemic absorption.
   • D.Increase the IV infusion rate to reduce exposure of the kidneys to the medication.

   Rationale: Gentamicin is eliminated by the kidneys and can cause nephrotoxicity. A substantial creatinine increase warrants withholding the next dose while contacting the provider for evaluation of renal function, drug levels, and dosing. Hepatic elimination does not protect this client from accumulation. Food does not alter absorption of IV gentamicin. Increasing the infusion rate does not reduce nephrotoxicity and is not a safe dosing adjustment.

2. 2.A client with deep vein thrombosis has a prescription for heparin at 18 units/kg/hr. The client weighs 80 kg, and the infusion contains 25,000 units in 250 mL of 0.9% sodium chloride. At which rate should the nurse program the infusion pump?

   • A.1.44 mL/hr
   • B.8 mL/hr
   • C.18 mL/hr
   • D.14.4 mL/hr

   Rationale: The prescribed dose is 18 units/kg/hr x 80 kg = 1,440 units/hr. The concentration is 25,000 units divided by 250 mL = 100 units/mL. Therefore, 1,440 units/hr divided by 100 units/mL = 14.4 mL/hr. A rate of 1.44 mL/hr gives one-tenth of the prescribed dose; 8 mL/hr gives 800 units/hr; and 18 mL/hr gives 1,800 units/hr. Follow facility policy for verification of this high-alert infusion.

3. 3.A postoperative client who received IV morphine is difficult to arouse, has a respiratory rate of 6/min, and has an oxygen saturation of 84%. The nurse stops opioid administration, calls for assistance, and supports oxygenation and ventilation. Which medication should the nurse anticipate administering?

   • A.Naloxone
   • B.Flumazenil
   • C.Atropine
   • D.Acetylcysteine

   Rationale: Naloxone is an opioid antagonist that reverses morphine-induced respiratory depression. Continued respiratory monitoring and repeat doses may be needed because naloxone can wear off before morphine does. Flumazenil reverses benzodiazepine effects, not opioid effects. Atropine treats selected symptomatic bradycardias and muscarinic toxicity but does not reverse opioid respiratory depression. Acetylcysteine treats acetaminophen toxicity and can be used as a mucolytic.

4. 4.A client taking lithium for bipolar disorder started hydrochlorothiazide 1 week ago. The client now reports vomiting and has a coarse hand tremor and an unsteady gait. Which action should the nurse take?

   • A.Administer the next lithium dose with food and reassess in 1 hour.
   • B.Encourage sodium restriction and continue both medications.
   • C.Withhold lithium and promptly notify the provider for evaluation of possible toxicity.
   • D.Reassure the client that these findings are expected during lithium maintenance therapy.

   Answer and rationale are in the full material.

5. 5.A client with type 1 diabetes is scheduled to receive insulin lispro before breakfast and insulin glargine each morning. The breakfast tray has been delayed, and the client's blood glucose is 112 mg/dL. Which action is appropriate?

   • A.Administer both insulins now because the blood glucose is within the target range.
   • B.Delay the meal-related lispro until food is available and administer the prescribed glargine.
   • C.Mix the lispro and glargine in one syringe and administer them when breakfast arrives.
   • D.Omit both insulins for the day because the client has not eaten.

   Answer and rationale are in the full material.