NACE Pharmacological and Parenteral Therapies 5 — Questions and Answers
Question 1: A patient with type 2 diabetes is prescribed metformin. Which condition is an absolute contraindication to its use?
- Mild obesity
- Stage 3b chronic kidney disease (GFR < 45 mL/min) (Correct answer)
- Hypertension controlled with ACE inhibitors
- History of urinary tract infections
Correct answer: Stage 3b chronic kidney disease (GFR < 45 mL/min)
Metformin is contraindicated in significant renal impairment (GFR < 30 mL/min and used cautiously below 45) due to risk of lactic acidosis.
Question 2: A nurse is administering potassium chloride 40 mEq IV. Which practice is safest?
- Administer as an IV push over 5 minutes
- Dilute in at least 100 mL and infuse no faster than 10 mEq/hour (Correct answer)
- Mix with normal saline in a 1 mEq/mL concentration and push slowly
- Add to a 50 mL minibag and infuse over 15 minutes
Correct answer: Dilute in at least 100 mL and infuse no faster than 10 mEq/hour
IV potassium must be diluted and infused slowly (≤10 mEq/hr peripherally) to prevent cardiac dysrhythmias; IV push is never acceptable.
Question 3: A patient taking phenytoin for seizure disorder has a serum level of 25 mcg/mL. Which symptom should the nurse assess for?
- Hypertension and tachycardia
- Nystagmus, ataxia, and confusion (Correct answer)
- Polyuria and polydipsia
- Peripheral edema and weight gain
Correct answer: Nystagmus, ataxia, and confusion
Phenytoin toxicity (therapeutic range 10–20 mcg/mL) commonly manifests as nystagmus, ataxia, and mental status changes.
Question 4: Which nursing action is most important before administering the first dose of an aminoglycoside antibiotic such as gentamicin?
- Obtain baseline hearing assessment and renal function tests (Correct answer)
- Administer a test dose to check for hypersensitivity
- Ensure the patient has taken a loading dose of a penicillin
- Check the patient's blood glucose level
Correct answer: Obtain baseline hearing assessment and renal function tests
Aminoglycosides are ototoxic and nephrotoxic; baseline hearing and renal function must be established before initiating therapy.
Question 5: A patient receiving morphine for post-operative pain has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the priority intervention?
- Administer naloxone (Narcan) per protocol (Correct answer)
- Increase the oxygen flow rate to 4 L/min
- Withhold the next scheduled morphine dose
- Reposition the patient to improve airway patency
Correct answer: Administer naloxone (Narcan) per protocol
Respiratory depression with altered consciousness is opioid toxicity requiring immediate naloxone administration to reverse the effect.
Question 6: A patient is receiving IV amphotericin B. Which assessment finding is most expected and requires ongoing monitoring?
- Elevated blood glucose
- Rising serum creatinine (Correct answer)
- Decreased white blood cell count
- Prolonged prothrombin time
Correct answer: Rising serum creatinine
Nephrotoxicity is the most significant dose-limiting adverse effect of amphotericin B, requiring frequent monitoring of renal function.
Question 7: The nurse is preparing to administer insulin glargine (Lantus) to a patient. Which action is correct?
- Mix with regular insulin in the same syringe for convenience
- Administer subcutaneously at the same time each day (Correct answer)
- Shake the vial vigorously to mix before drawing up
- Give IV push if the patient is NPO before surgery
Correct answer: Administer subcutaneously at the same time each day
Insulin glargine is a long-acting basal insulin given subcutaneously once daily at the same time; it must never be mixed or given IV.
NACE Pharmacological and Parenteral Therapies 5
A patient with type 2 diabetes is prescribed metformin.
Which condition is an absolute contraindication to its use?