Module 4
This medication is an ACE inhibitor used to treat hypertension and heart failure. It can cause a persistent dry cough and angioedema.
Captopril
A client diagnosed with GERD is prescribed omeprazole. What is the primary treatment goal for this client, and how does omeprazole help achieve it?
Reduce reflux symptoms, promote esophageal healing, and prevent complications. Omeprazole inhibits the gastric proton pump (H+/K+-ATPase), decreasing acid secretion.
A child diagnosed with growth hormone deficiency is prescribed somatropin. What is the primary therapeutic outcome the nurse should monitor?
Somatropin replaces growth hormone and promotes skeletal growth in children with open growth plates.
A 72-year-old patient with hypothyroidism and coronary artery disease is prescribed levothyroxine. Which nursing action is most appropriate?
A. Administer levothyroxine with calcium carbonate to prevent bone loss.
B. Monitor for chest pain, tachycardia, and palpitations after therapy begins.
C. Administer the medication with breakfast to increase absorption.
D. Expect the initial dose to be high to rapidly normalize TSH.
Answer B
Levothyroxine increases metabolic activity and myocardial oxygen demand. Older adults with coronary artery disease are generally started on lower doses and monitored for angina, tachycardia, and dysrhythmias. It should be taken on an empty stomach and separated from calcium.
client with pernicious anemia is prescribed vitamin B12 (cyanocobalamin). Which statement best describes its pharmacological action?
A.Stimulates gastric acid secretion to improve digestion
B.Promotes DNA synthesis, red blood cell maturation, and normal nerve function
C.Increases iron absorption by lowering gastric pH
D.Blocks intestinal serotonin receptors to slow motility
Answer: B
Vitamin B12 is necessary for DNA synthesis, normal red blood cell maturation, and maintenance of neurologic function, including myelin integrity.
A patient is starting prazosin for hypertension. The nurse should instruct the patient to take the first dose at this time to reduce the risk of fainting.
Prazosin can cause first-dose orthostatic hypotension. Taking the initial dose at bedtime and changing positions slowly reduces fall risk.
A 70-year-old takes ibuprofen daily for chronic arthritis. Which medication class is commonly prescribed to prevent NSAID-induced ulcers, and why are these clients at increased risk?
Proton pump inhibitors (PPIs), such as omeprazole. NSAIDs decrease prostaglandin synthesis, reducing the protective mucus, bicarbonate, and blood flow in the gastric mucosa.
A patient with central diabetes insipidus receives desmopressin. The patient develops headache, nausea, and sodium of 124 mEq/L. What complication should the nurse suspect?
Water intoxication with hyponatremia.
A nurse is providing discharge teaching to a patient with Graves disease who received radioactive iodine (I-131). Which statement indicates the patient needs further teaching?
A. I may eventually need to take levothyroxine for the rest of my life.
B. I should limit close contact with pregnant women and young children as instructed.
C. The radioactive iodine will immediately block thyroid hormone production within a few hours.
D. I will need follow-up thyroid function tests to evaluate treatment effectiveness.
C-
Radioactive iodine gradually destroys functioning thyroid tissue. Its full therapeutic effect may take weeks to months, not hours. Permanent hypothyroidism is common, and radiation precautions and follow-up testing are essential.
A client with ulcerative colitis is prescribed sulfasalazine. Which statement best describes its expected pharmacological action?
A.Blocks gastric H2 receptors to reduce acid production
B.Increases intestinal water absorption to prevent diarrhea
C.Stimulates peristalsis to remove inflammatory substances
D.Delivers an anti-inflammatory compound to the colon to reduce mucosal inflammation
Answer: D
Sulfasalazine is broken down by colonic bacteria, releasing 5-aminosalicylic acid (5-ASA), which acts locally to decrease intestinal inflammation.
This nonselective beta blocker can cause bronchospasm and should generally be avoided in patients with asthma.
Propranolol blocks beta-1 receptors in the heart and beta-2 receptors in the lungs. Blocking beta-2 can cause bronchoconstriction.
A postoperative client is constipated and has been instructed to avoid straining. The provider orders docusate sodium and psyllium. Identify the drug class of each and explain the most important nursing administration instruction for psyllium.
Docusate sodium is a stool softener that reduces straining. Psyllium is a bulk-forming laxative that absorbs water to increase stool bulk. Give psyllium with at least 8 oz (240 mL) of fluid and ensure adequate hydration.
A patient taking hydrocortisone for Addison disease develops vomiting, BP 82/46 mmHg, and severe weakness. What complication should the nurse suspect, and what treatment should be anticipated?
Adrenal crisis; emergency IV hydrocortisone and isotonic fluids.
A patient with a history of peptic ulcer disease takes naproxen daily. The provider prescribes omeprazole to prevent ulcer recurrence. Which statement best explains its action?
A.It blocks H2 receptors in gastric parietal cells.
B.It inhibits the gastric proton pump, reducing acid secretion.
C.It coats the gastric mucosa without affecting acid production.
D.It increases prostaglandin synthesis to replace NSAID losses.
Correct answer: B
Omeprazole is a proton pump inhibitor that suppresses the final step of gastric acid secretion. This helps prevent NSAID-associated ulcers.
A patient with chronic stable angina is prescribed ranolazine. Which statement correctly explains its mechanism of action?
A.Inhibits the late sodium current in myocardial cells, reducing intracellular calcium overload
B.Releases nitric oxide to dilate coronary arteries
C.Blocks beta-1 receptors to reduce heart rate and contractility
D.Blocks L-type calcium channels in vascular smooth muscle
A-
Ranolazine inhibits the late inward sodium current in cardiac cells, indirectly reducing intracellular calcium overload and improving myocardial relaxation. It generally has little effect on heart rate or blood pressure.
A patient taking digoxin reports nausea, loss of appetite, and yellow-green halos around lights. The nurse should suspect this medication complication.
Digoxin toxicity can cause GI symptoms, visual disturbances, bradycardia, and dysrhythmias. Hypokalemia increases the risk.
A woman taking alosetron for severe IBS-D develops new abdominal pain, constipation, and later bloody diarrhea. Identify the drug class, the serious complication of concern, and the priority nursing action.
Alosetron is a selective 5-HT3 receptor antagonist. Severe constipation and ischemic colitis are major risks. Stop the medication and arrange immediate medical evaluation.
A patient with DKA has glucose 480 mg/dL, potassium 2.9 mEq/L, and an order for IV regular insulin. What is the priority nursing action?
Hold insulin temporarily, notify the provider, and initiate prescribed potassium replacement.
A patient experiencing a hypertensive emergency is receiving IV sodium nitroprusside. After a prolonged infusion, the patient develops confusion, tachycardia, and metabolic acidosis. Which complication should the nurse suspect?
A.Acute digoxin toxicity
B.Cyanide toxicity
C.Drug-induced lupus
D.Rebound hypertension
Nitroprusside releases cyanide during metabolism. Prolonged or high-dose infusions increase the risk of cyanide toxicity. The nurse should stop the infusion and immediately notify the provider.
A patient with heart failure is prescribed digoxin. Which pharmacological action explains how digoxin improves cardiac contractility?
A.Blocks beta-1 receptors to decrease cardiac workload
B.Inhibits calcium entry into myocardial cells
C.Stimulates alpha-1 receptors to increase vascular resistance
D.Inhibits the sodium-potassium ATPase pump, increasing intracellular calcium
D
Digoxin inhibits Na⁺/K⁺-ATPase, indirectly increasing intracellular calcium. This produces a positive inotropic effect, meaning stronger cardiac contractions.
A patient receiving procainamide develops a prolonged QT interval on the ECG. This life-threatening ventricular dysrhythmia is the major concern.
What is torsades de pointes?
Procainamide is a Class IA sodium channel blocker that prolongs repolarization. QT prolongation can trigger torsades de pointes. The nurse should monitor ECG, BP, and electrolytes and report concerning changes immediately.
During IV magnesium sulfate therapy, a client develops absent deep tendon reflexes, a respiratory rate of 8/min, and decreased responsiveness. What complication is occurring, which antidote should the nurse prepare, and what is the immediate nursing priority?
Magnesium toxicity. The antidote is IV calcium gluconate. Immediately stop the magnesium infusion, assess and support airway and breathing, and activate emergency assistance.
A patient with Graves disease receives methimazole. Three weeks later, the patient develops fever, sore throat, and mouth ulcers. Explain the suspected complication, the underlying medication effect, and the priority nursing intervention.
Suspect agranulocytosis. Methimazole can severely reduce neutrophils, increasing infection risk. Withhold the medication and obtain urgent provider evaluation and a CBC with differential.
A nurse reviews the medication history of a client taking alosetron for severe IBS-D. Which findings require immediate follow-up or questioning of the medication? Select all that apply.
A.The client reports new-onset constipation.
B.The client has a history of ischemic colitis.
C.The client reports bloody diarrhea with abdominal pain.
D.The client has severe IBS-D unresponsive to conventional therapy.
A, B, C
Alosetron can cause severe constipation and ischemic colitis. New constipation requires stopping the drug, a history of ischemic colitis is a contraindication, and bloody diarrhea with abdominal pain requires immediate evaluation. Severe refractory IBS-D is an indication, not a contraindication.
A patient with Graves disease is prescribed methimazole. Which statement best describes the pharmacological action of this medication?
A. It destroys thyroid follicular cells through radioactive emissions.
B. It inhibits thyroid peroxidase, preventing the synthesis of new thyroid hormones.
C. It blocks the release of stored T3 and T4 from the thyroid gland.
D. It inhibits peripheral conversion of T4 to T3 without affecting thyroid hormone synthesis.
B-
Rationale: Methimazole inhibits thyroid peroxidase, preventing iodination and coupling reactions necessary for T3 and T4 synthesis. It does not destroy thyroid tissue or immediately eliminate stored hormones, so its therapeutic effects take time.