CARDIAC
A patient is prescribed atorvastatin for hyperlipidemia. Which assessment finding should the nurse instruct the patient to report immediately?
Unexplained muscle pain or weakness.
Rationale:
Statins can cause myopathy and rhabdomyolysis, rare but serious adverse effects that can lead to acute kidney injury. Patients should promptly report muscle pain, tenderness, weakness, or dark-colored urine.
A nurse is teaching a patient about albuterol. Which common side effect should the patient anticipate?
Tachycardia and tremors
Rationale:
Beta2-agonists can stimulate beta receptors, resulting in increased heart rate and muscle tremors.
A patient taking omeprazole for several years is at increased risk for deficiency of which vitamin?
Vitamin B12
Rationale:
Proton pump inhibitors reduce gastric acid production, impairing vitamin B12 absorption.
A patient is prescribed gabapentin for neuropathic pain. Which instruction is most important for the nurse to include when teaching about this medication?
Avoid driving or operating heavy machinery until the effects of the medication are known.
Rationale:
Gabapentin commonly causes dizziness, drowsiness, and sedation, especially when therapy is initiated or doses are increased. Patients should be cautioned about activities requiring alertness until they know how the medication affects them.
Which insulin provides basal glucose control and typically has no pronounced peak?
Insulin glargine
Rationale:
Glargine provides steady insulin coverage over approximately 24 hours.
A patient receiving IV amiodarone reports increasing shortness of breath and a nonproductive cough. Which serious adverse effect should the nurse suspect?
Pulmonary toxicity (pulmonary fibrosis)
Rationale:
Amiodarone can cause pulmonary fibrosis, one of its most serious adverse effects. New respiratory symptoms require immediate evaluation.
A patient uses fluticasone daily for asthma control. What instruction is most important after administration?
Rinse the mouth after each use.
Rationale:
Inhaled corticosteroids increase the risk of oral candidiasis (thrush). Rinsing reduces this risk.
A patient with hepatic encephalopathy receives lactulose. Which finding indicates the medication is effective?
Decreased serum ammonia levels
Rationale:
Lactulose traps ammonia in the GI tract and promotes its elimination through the stool.
A patient receiving morphine becomes difficult to arouse with respirations of 6/min. What medication should the nurse anticipate administering?
Naloxone
Rationale:
Naloxone rapidly reverses opioid-induced respiratory depression.
A patient taking levothyroxine reports insomnia, palpitations, and weight loss. What is the most likely explanation?
Excessive thyroid hormone replacement
Rationale:
Overreplacement can cause symptoms of hyperthyroidism.
A patient is prescribed warfarin and begins taking fluconazole. Which assessment finding would be most concerning?
Elevated INR and bleeding risk
Rationale:
Fluconazole (Diflucan) increases warfarin's anticoagulant effects, significantly increasing bleeding risk.
A patient with asthma states, “I use my albuterol inhaler 4 to 5 times every day.” What does the nurse recognize this finding most likely indicates?
Poor asthma control requiring reassessment of the treatment plan.
Rationale:
Frequent use of a short-acting beta₂-agonist (SABA) such as albuterol indicates that the patient's asthma is not well controlled. Reliance on a rescue inhaler more than prescribed suggests inadequate long-term management and may necessitate adjustment of controller medications, such as inhaled corticosteroids. Increased SABA use is also associated with a higher risk of severe asthma exacerbations.
A patient taking metoclopramide develops repetitive facial grimacing and tongue movements. What adverse effect is occurring?
Tardive dyskinesia
Rationale:
Long-term dopamine blockade can lead to potentially irreversible extrapyramidal symptoms.
A patient taking phenelzine eats aged cheese and develops a severe headache and elevated BP. What is occurring?
Hypertensive crisis
Rationale:
MAOIs interact with tyramine-containing foods, causing dangerous elevations in blood pressure.
A patient abruptly stops taking prednisone after several months of therapy. Which life-threatening complication is the priority concern?
Adrenal crisis
Rationale:
Chronic corticosteroid therapy suppresses natural cortisol production, requiring gradual tapering.
A patient taking lisinopril develops facial swelling, difficulty swallowing, and hoarseness. What adverse reaction is occurring?
Angioedema
Rationale:
ACE inhibitors can cause angioedema, a potentially life-threatening airway emergency requiring immediate intervention.
A patient taking theophylline develops severe tachycardia and agitation. Which laboratory value would support the nurse's suspicion?
Elevated theophylline level above the therapeutic range
Rationale:
Theophylline has a narrow therapeutic index. Toxicity commonly produces neurologic and cardiac manifestations.
A patient taking tamsulosin for benign prostatic hyperplasia (BPH) states, "The medication isn't working because I'm still waking up at night to urinate." Which finding would indicate the medication is having its intended therapeutic effect?
Improved urinary stream and decreased difficulty initiating urination
Rationale:
Tamsulosin is an alpha-1 adrenergic blocker that relaxes smooth muscle in the prostate and bladder neck, improving urine flow. While symptoms such as nocturia may take longer to improve, decreased hesitancy and a stronger urinary stream are indicators that the medication is working.
A Parkinson's patient taking carbidopa/levodopa develops severe involuntary movements. What complication should the nurse suspect?
Levodopa-induced dyskinesia
Rationale:
High dopamine levels from therapy may result in abnormal involuntary movements.
A patient prescribed methimazole develops a fever and sore throat. Which laboratory value is the priority to assess?
White blood cell count
Rationale:
Methimazole (an anti-thyroid medication that treats hyperthyroidism) can cause agranulocytosis, placing patients at high risk for severe infection.
A patient with heart failure receives spironolactone, lisinopril, and potassium supplements. Which abnormal lab requires immediate notification to the provider?
Hyperkalemia
Rationale:
All three treatments can increase potassium levels. Severe hyperkalemia can lead to fatal cardiac dysrhythmias.
A patient with pulmonary arterial hypertension is prescribed sildenafil. Which concurrent medication would require the nurse to question the prescription because of the risk of life-threatening hypotension?
Nitroglycerin (or any nitrate medication)
Rationale:
Sildenafil causes vasodilation by increasing nitric oxide effects. When combined with nitrates, profound hypotension can occur, leading to syncope, shock, or death.
A patient prescribed oxybutynin reports dry mouth, blurred vision, constipation, and urinary retention. What best explains these symptoms?
Anticholinergic effects
Rationale:
Oxybutynin blocks muscarinic receptors, producing classic anticholinergic adverse effects.
A patient receiving fentanyl and sertraline develops hyperthermia, agitation, tremors, and hyperreflexia. What condition is most likely occurring?
Serotonin syndrome
Rationale:
Concurrent serotonergic medications may result in excess serotonin activity, producing a potentially life-threatening syndrome.
A patient with Cushing syndrome is prescribed ketoconazole. During routine follow-up, the nurse recognizes that this medication places which organ at the greatest risk for failure?
The liver
Rationale:
Ketoconazole inhibits cortisol synthesis but can also cause significant hepatotoxicity. Patients receiving this medication require monitoring of liver function tests because severe liver injury and liver failure are potential adverse effects.