MSNCB Pharmacology & Medication Management 4 — Questions and Answers
Question 1: A patient with a penicillin allergy is ordered cefazolin. The nurse's priority action is to:
- Administer the cefazolin as ordered since cross-reactivity is rare
- Refuse to administer and document in the chart
- Clarify the nature of the penicillin allergy with the patient and provider before administration (Correct answer)
- Substitute with a fluoroquinolone without consulting the provider
Correct answer: Clarify the nature of the penicillin allergy with the patient and provider before administration
Cross-reactivity between penicillins and cephalosporins exists, especially with anaphylactic penicillin reactions; the nurse must clarify the type of allergy and consult the provider.
Question 2: A nurse notes that a patient's morning potassium is 3.0 mEq/L. The patient is also taking digoxin. The nurse should:
- Administer the digoxin and recheck potassium in 4 hours
- Hold the digoxin and notify the provider of the potassium level (Correct answer)
- Administer the digoxin with orange juice to boost potassium
- Administer the digoxin since 3.0 mEq/L is only mildly low
Correct answer: Hold the digoxin and notify the provider of the potassium level
Hypokalemia increases sensitivity to digoxin toxicity; the medication should be withheld and the provider notified for potassium correction orders.
Question 3: Which assessment finding would prompt the nurse to hold a scheduled dose of morphine?
- Pain score of 4/10
- Respiratory rate of 10 breaths/min (Correct answer)
- Blood pressure of 130/80 mmHg
- Heart rate of 88 bpm
Correct answer: Respiratory rate of 10 breaths/min
A respiratory rate below 12 breaths/min indicates opioid-induced respiratory depression, requiring the nurse to hold the medication and notify the provider.
Question 4: A patient is prescribed phenytoin (Dilantin) IV. Which solution is compatible for administration?
- Dextrose 5% in water (D5W)
- Normal saline (0.9% NaCl) (Correct answer)
- Lactated Ringer's solution
- Dextrose 5% in 0.45% NaCl
Correct answer: Normal saline (0.9% NaCl)
Phenytoin precipitates in dextrose-containing solutions and must be administered in normal saline (0.9% NaCl) only.
Question 5: A patient prescribed prednisone long-term should be monitored for which complication?
- Hypoglycemia
- Osteoporosis (Correct answer)
- Bradycardia
- Thrombocytosis
Correct answer: Osteoporosis
Long-term corticosteroid use inhibits osteoblast activity and calcium absorption, significantly increasing the risk of osteoporosis and fractures.
Question 6: The six rights of medication administration include the right patient, drug, dose, route, time, and which sixth right?
- Right diagnosis
- Right documentation (Correct answer)
- Right practitioner
- Right indication
Correct answer: Right documentation
The sixth right of medication administration is right documentation, which ensures accurate recording after administration to prevent duplicate dosing.
Question 7: A patient receiving IV amphotericin B develops rigors and fever during infusion. The most appropriate pre-medication to prevent this reaction is:
- Acetaminophen and diphenhydramine (Correct answer)
- Ondansetron and lorazepam
- Methylprednisolone and epinephrine
- Famotidine and cetirizine
Correct answer: Acetaminophen and diphenhydramine
Acetaminophen and diphenhydramine (with or without hydrocortisone) are standard pre-medications used to reduce infusion-related reactions to amphotericin B.
MSNCB Pharmacology & Medication Management 4
A patient with a penicillin allergy is ordered cefazolin.
The nurse's priority action is to: