Hesi Rn 301 pharmacology Exam

Correct Answer:

Naloxone

Explanation:

Naloxone is an opioid antagonist that rapidly reverses the effects of opioids, including respiratory depression, sedation, and hypotension. It works by competitively binding to opioid receptors without activating them. In clients receiving opioid therapy, having naloxone readily available is a critical safety measure, especially in the immediate postoperative period or with high opioid doses.

Why Other Options Are Incorrect:

Flumazenil

Used to reverse benzodiazepine effects, not opioids.

Protamine sulfate

Antidote for heparin overdose, unrelated to opioid reversal.

Vitamin K

Reverses warfarin-induced anticoagulation, not opioid effects.

Correct Answer D. Assess the client for signs of hypoglycemia.

Explanation:

Fluconazole, an antifungal medication, can enhance the effects of certain oral hypoglycemic agents (such as sulfonylureas), potentially causing hypoglycemia in diabetic patients. The nurse should closely monitor blood glucose levels and assess for signs such as sweating, confusion, tremors, and palpitations. Client teaching should include recognizing hypoglycemia symptoms and promptly reporting them. Adjustments to diabetes medication may be required based on blood sugar readings.

Why Other Options Are Incorrect:

A. Instruct the client to chew the tablet

Fluconazole tablets should be swallowed whole, not chewed, to ensure proper dosing and absorption.

B. Double the dose the next day if a dose is missed

Patients should never double up on doses to compensate for a missed dose, as this increases the risk of toxicity. Instead, they should take the missed dose as soon as remembered unless it's near the next scheduled dose.

C. Provide at least eight glasses of water daily

While hydration is important, excessive fluid intake is not specifically required for fluconazole use. This is more crucial for certain drugs that can crystallize in the kidneys, such as sulfonamides.

Correct Answer:

CT scan with IV contrast

Explanation:

Metformin is held before procedures involving iodinated IV contrast because contrast can cause acute kidney injury (AKI). Reduced kidney function can impair metformin clearance, increasing the risk of lactic acidosis, a rare but potentially fatal complication. Metformin is usually withheld the day of the procedure and restarted only after renal function has been reassessed and confirmed to be stable.

Why Other Options Are Incorrect:

Colonoscopy with sedation

Sedation does not increase the risk of lactic acidosis with metformin; the medication is usually continued unless otherwise directed.

Skin biopsy under local anesthesia

This minor procedure has no interaction with metformin.

Ear irrigation

This procedure does not affect kidney function or metformin metabolism.

Correct Answer A. Acetaminophen

Explanation:

Acetaminophen is preferred for mild postsurgical pain in a patient receiving gentamicin and a cephalosporin because it is effective for pain relief and has no significant nephrotoxic effects. Both gentamicin (an aminoglycoside) and cephalosporins can be nephrotoxic, so avoiding NSAIDs like aspirin and ibuprofen—which also reduce renal blood flow—is important to prevent additive kidney injury. Acetaminophen is safe for the kidneys at therapeutic doses and does not increase bleeding risk.

Why Other Options Are Incorrect:

B. Aspirin

Although effective for pain, aspirin increases bleeding risk and can cause gastrointestinal irritation. In a postoperative patient, especially one on antibiotics that may already stress the kidneys, aspirin also poses nephrotoxic risks.

C. Ibuprofen

As an NSAID, ibuprofen can impair renal perfusion, increasing the risk of kidney injury when combined with nephrotoxic antibiotics like gentamicin and cephalosporins. It also increases bleeding risk in postoperative patients.

D. Morphine

While morphine can relieve pain, it is generally reserved for moderate to severe pain, not mild discomfort. Opioids also have side effects such as respiratory depression, constipation, and sedation, which are unnecessary for mild pain.

Correct Answer A. Dry mouth

Explanation:

Amitriptyline is a tricyclic antidepressant that has strong anticholinergic effects, leading to common side effects such as dry mouth, constipation, blurred vision, and urinary retention. These occur because the drug blocks acetylcholine receptors. Monitoring for and addressing dry mouth is important to prevent discomfort and oral health problems.

Why Other Options Are Incorrect:

B. Hypoglycemia

Amitriptyline does not significantly affect blood glucose regulation; hypoglycemia is not a common adverse effect.

C. Hyperkalemia

This drug does not alter potassium levels; hyperkalemia is more associated with potassium-sparing diuretics or ACE inhibitors.

D. Bradycardia

Amitriptyline may cause orthostatic hypotension or tachycardia, but bradycardia is not a typical adverse effect.

Correct Answers:

B. Gentamicin

E. Amikacin

F. Tobramycin

Explanation of Correct Answers:

B. Gentamicin

An aminoglycoside antibiotic used to treat serious gram-negative bacterial infections. It works by binding to the 30S ribosomal subunit, causing misreading of mRNA and inhibiting protein synthesis. It is associated with nephrotoxicity and ototoxicity, requiring careful monitoring of drug levels.

E. Amikacin

A broad-spectrum aminoglycoside often reserved for infections resistant to other aminoglycosides. It is particularly effective against Pseudomonas aeruginosa and other multidrug-resistant gram-negative bacteria. Like other drugs in its class, it can cause hearing loss and kidney damage.

F. Tobramycin

An aminoglycoside used for serious gram-negative infections and sometimes inhaled for cystic fibrosis-related lung infections. It shares the same mechanism of action as other aminoglycosides and carries similar toxicity risks, making monitoring essential.

Why Other Options Are Incorrect:

A.Tetracycline

Belongs to the tetracycline class of antibiotics, not aminoglycosides. It also binds to the 30S ribosomal subunit but differs in structure, spectrum, and toxicity profile.

C. Cefazolin

A first-generation cephalosporin antibiotic that disrupts bacterial cell wall synthesis. It is primarily used for gram-positive coverage and surgical prophylaxis, not classifiedas an aminoglycoside.

D. Ciprofloxacin

A fluoroquinolone antibiotic that inhibits DNA gyrase and topoisomerase IV, interfering with bacterial DNA replication. It is unrelated to aminoglycosides in both structure and mechanism.

Correct Answer:

“I will take it on an empty stomach in the morning.”

Explanation:

Levothyroxine absorption is best on an empty stomach, typically 30–60 minutes before breakfast, with water only. It should be taken consistently at the same time daily. Therapy is lifelong, and absorption can be reduced by calcium, iron, and certain antacids.

Why Other Options Are Incorrect:

“I should take it with my calcium supplement.”

Calcium interferes with absorption.

“I can stop taking it when I feel better.”

Discontinuing can cause hypothyroid symptoms to return.

“I’ll take it at night for better absorption.”

Morning dosing is preferred to mimic natural hormone rhythm.

Correct Answer C. I can skip meals if I’m not hungry.

Explanation:

Metformin should be taken with meals to reduce gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort. Skipping meals while taking metformin increases the risk of hypoglycemia if used with other glucose-lowering medications, and it can also worsen gastrointestinal upset. Clients should be instructed to maintain regular meal schedules to support stable blood glucose levels and medication tolerance.

Why Other Options Are Incorrect:

A. I will stop taking this before a CT scan with contrast.

This is correct and indicates understanding. Metformin should be withheld before and for 48 hours after contrast dye to prevent lactic acidosis, especially in clients with impaired renal function.

B. This medicine helps my body use insulin better.

This is accurate. Metformin improves insulin sensitivity and reduces hepatic glucose production, which helps control blood sugar in type 2 diabetes.

D. I should monitor my blood sugar regularly.

This is correct. Even though metformin does not usually cause hypoglycemia alone, regular glucose monitoring is important to track the effectiveness of therapy and detect abnormal levels early.

Correct Answer B. Risk for injury (renal damage)

Explanation:

Aminoglycosides such as gentamicin, tobramycin, and amikacin carry a significant risk of nephrotoxicity, especially with prolonged use or high trough levels. The drug can damage renal tubules, leading to elevated creatinine and BUN levels, decreased urine output, and electrolyte imbalances. Because this adverse effect can be irreversible if not identified early, “Risk for injury (renal damage)” is a priority nursing diagnosis. Nursing care should focus on monitoring kidney function, adjusting doses for renal impairment, and ensuring adequate hydration.

Why Other Options Are Incorrect:

A. Constipation

Aminoglycosides are not commonly associated with constipation. This would not be a priority nursing diagnosis compared to the risk of renal damage.

C. Disturbed body image related to gynecomastia

Gynecomastia is not a recognized side effect of aminoglycosides, making this diagnosis irrelevant to this therapy.

D. Imbalanced nutrition, less than body requirements, related to nausea

Although nausea can occur with aminoglycosides, it is not the most significant or dangerous adverse effect. The risk for irreversible kidney injury is a higher priority.