MSNCB Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A patient receiving warfarin has an INR of 4.8. Which action should the nurse take first?
- Administer vitamin K as ordered
- Hold the next warfarin dose
- Notify the provider immediately (Correct answer)
- Recheck the INR in 1 hour
Correct answer: Notify the provider immediately
An INR of 4.8 is supratherapeutic and places the patient at high bleeding risk, requiring immediate provider notification.
Question 2: Which electrolyte imbalance is most associated with digoxin toxicity?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia potentiates digoxin toxicity by increasing drug binding to myocardial cells and reducing renal elimination.
Question 3: A nurse is preparing to administer metformin. Which condition is an absolute contraindication?
- Type 2 diabetes with BMI >30
- Chronic kidney disease with eGFR 25 mL/min (Correct answer)
- Hypertension controlled with ACE inhibitor
- Mild hepatic steatosis
Correct answer: Chronic kidney disease with eGFR 25 mL/min
Metformin is contraindicated when eGFR is <30 mL/min/1.73 m² due to risk of lactic acidosis from drug accumulation.
Question 4: Which medication classification requires a baseline hearing assessment before initiation?
- Beta-blockers
- Aminoglycosides (Correct answer)
- Calcium channel blockers
- SSRIs
Correct answer: Aminoglycosides
Aminoglycosides are ototoxic and can cause irreversible sensorineural hearing loss, necessitating baseline and ongoing audiologic monitoring.
Question 5: A patient on heparin infusion develops sudden onset of thrombocytopenia and new clots on day 7 of therapy. The nurse suspects:
- Disseminated intravascular coagulation
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Warfarin skin necrosis
- Anaphylaxis to heparin
Correct answer: Heparin-induced thrombocytopenia (HIT)
HIT classically presents with thrombocytopenia and paradoxical thrombosis 5–10 days after heparin initiation due to immune-mediated platelet activation.
Question 6: When educating a patient newly prescribed lisinopril, the nurse should instruct the patient to report which adverse effect?
- Peripheral edema
- Dry, persistent cough (Correct answer)
- Increased urination
- Photosensitivity
Correct answer: Dry, persistent cough
ACE inhibitors like lisinopril commonly cause a dry, nonproductive cough due to bradykinin accumulation in the lungs.
Question 7: A patient is receiving IV vancomycin. The nurse notices flushing, erythema, and hypotension during infusion. The priority action is to:
- Discontinue vancomycin permanently and notify pharmacy
- Stop the infusion and administer diphenhydramine
- Slow the infusion rate and monitor the patient (Correct answer)
- Obtain blood cultures before stopping the infusion
Correct answer: Slow the infusion rate and monitor the patient
Red Man Syndrome is an infusion rate-related reaction to vancomycin; slowing the infusion rate typically resolves symptoms and is the first intervention.
MSNCB Pharmacology & Medication Management 2
A patient receiving warfarin has an INR of 4.8.
Which action should the nurse take first?