SET 3
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1. CASE SCENARIO (NGN-Style):
A 63-year-old client with chronic kidney disease has been receiving epoetin
alfa (Epogen) three times a week for anemia management. Today, lab
results show hemoglobin (Hgb) has increased from 7 g/dL to 8.5 g/dL in just
one week. Current vitals: BP 148/88 mmHg, HR 88/min, RR 18/min, Temp
98.2°F (36.8°C).
QUESTION:
Which action should the nurse expect to take regarding today’s dose of
epoetin alfa?
A. Increase today’s dose.
B. Administer the ordered dose.
C. Withhold today’s dose.
D. Discontinue the medication.
• Correct Answer: C. Withhold today’s dose
• Rationale: A rapid rise in hemoglobin (more than 1 g/dL in 2 weeks)
increases the risk of serious cardiovascular events (e.g., hypertension,
thrombotic events). Providers often hold or adjust the dose to prevent
complications.
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2. CASE SCENARIO (NGN-Style):
A preschool-age child arrives at the emergency department with a parent
who suspects the child may have accidentally taken multiple
diphenhydramine (Benadryl) tablets. The child is restless and intermittently
crying. Vital signs: HR 120/min, RR 30/min, Temp 99.0°F (37.2°C).
QUESTION:
To identify antihistamine (diphenhydramine) toxicity, the nurse should
monitor the child for:
A. Hallucinations
B. Bradycardia
C. Pinpoint pupils
D. Pallor
• Correct Answer: A. Hallucinations
• Rationale: Excess diphenhydramine can lead to CNS excitation in
children, manifesting as hallucinations, seizures, and hyperactivity.
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3. CASE SCENARIO:
,A client with congestive heart failure is starting spironolactone (Aldactone).
Morning labs show: Na⁺ 138 mEq/L, K⁺ 5.2 mEq/L, Creatinine 1.2 mg/dL,
Cl⁻ 106 mEq/L. Vital signs: BP 128/82 mmHg, HR 88/min, RR 20/min.
QUESTION:
Which lab value warrants withholding the morning dose and notifying the
provider?
A. Sodium 138 mEq/L
B. Potassium 5.2 mEq/L
C. Serum creatinine 1.2 mg/dL
D. Chloride 106 mEq/L
• Correct Answer: B. Potassium 5.2 mEq/L
• Rationale: Spironolactone is a potassium-sparing diuretic. Elevated serum
potassium (5.2 mEq/L) places the client at risk for hyperkalemia and
cardiac dysrhythmias.
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4. CASE SCENARIO:
A 45-year-old client with a history of hypertension is being evaluated for
propranolol (Inderal) therapy. The client’s past medical history includes mild
asthma, type 2 diabetes, and stable angina.
QUESTION:
, Propranolol is contraindicated for a client who has which of the following
conditions?
A. Asthma
B. Diabetes
C. Angina
D. Dementia
• Correct Answer: A. Asthma
• Rationale: Propranolol (a nonselective beta-blocker) can cause
bronchoconstriction and is contraindicated in clients with asthma.
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5. CASE SCENARIO:
A client has been taking digoxin (Lanoxin) 0.125 mg daily and furosemide
(Lasix) 40 mg daily. Current serum potassium is 3.2 mEq/L. Vital signs: BP
110/70 mmHg, HR 64/min, RR 16/min.
QUESTION:
For which medication interaction is the client at risk with K⁺ = 3.2 mEq/L?
A. Toxic levels of furosemide
B. Toxic levels of digoxin
C. Subtherapeutic levels of furosemide
D. Subtherapeutic levels of digoxin
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1. CASE SCENARIO (NGN-Style):
A 63-year-old client with chronic kidney disease has been receiving epoetin
alfa (Epogen) three times a week for anemia management. Today, lab
results show hemoglobin (Hgb) has increased from 7 g/dL to 8.5 g/dL in just
one week. Current vitals: BP 148/88 mmHg, HR 88/min, RR 18/min, Temp
98.2°F (36.8°C).
QUESTION:
Which action should the nurse expect to take regarding today’s dose of
epoetin alfa?
A. Increase today’s dose.
B. Administer the ordered dose.
C. Withhold today’s dose.
D. Discontinue the medication.
• Correct Answer: C. Withhold today’s dose
• Rationale: A rapid rise in hemoglobin (more than 1 g/dL in 2 weeks)
increases the risk of serious cardiovascular events (e.g., hypertension,
thrombotic events). Providers often hold or adjust the dose to prevent
complications.
,───────────────────────────────────────────────
─────────
2. CASE SCENARIO (NGN-Style):
A preschool-age child arrives at the emergency department with a parent
who suspects the child may have accidentally taken multiple
diphenhydramine (Benadryl) tablets. The child is restless and intermittently
crying. Vital signs: HR 120/min, RR 30/min, Temp 99.0°F (37.2°C).
QUESTION:
To identify antihistamine (diphenhydramine) toxicity, the nurse should
monitor the child for:
A. Hallucinations
B. Bradycardia
C. Pinpoint pupils
D. Pallor
• Correct Answer: A. Hallucinations
• Rationale: Excess diphenhydramine can lead to CNS excitation in
children, manifesting as hallucinations, seizures, and hyperactivity.
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3. CASE SCENARIO:
,A client with congestive heart failure is starting spironolactone (Aldactone).
Morning labs show: Na⁺ 138 mEq/L, K⁺ 5.2 mEq/L, Creatinine 1.2 mg/dL,
Cl⁻ 106 mEq/L. Vital signs: BP 128/82 mmHg, HR 88/min, RR 20/min.
QUESTION:
Which lab value warrants withholding the morning dose and notifying the
provider?
A. Sodium 138 mEq/L
B. Potassium 5.2 mEq/L
C. Serum creatinine 1.2 mg/dL
D. Chloride 106 mEq/L
• Correct Answer: B. Potassium 5.2 mEq/L
• Rationale: Spironolactone is a potassium-sparing diuretic. Elevated serum
potassium (5.2 mEq/L) places the client at risk for hyperkalemia and
cardiac dysrhythmias.
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4. CASE SCENARIO:
A 45-year-old client with a history of hypertension is being evaluated for
propranolol (Inderal) therapy. The client’s past medical history includes mild
asthma, type 2 diabetes, and stable angina.
QUESTION:
, Propranolol is contraindicated for a client who has which of the following
conditions?
A. Asthma
B. Diabetes
C. Angina
D. Dementia
• Correct Answer: A. Asthma
• Rationale: Propranolol (a nonselective beta-blocker) can cause
bronchoconstriction and is contraindicated in clients with asthma.
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5. CASE SCENARIO:
A client has been taking digoxin (Lanoxin) 0.125 mg daily and furosemide
(Lasix) 40 mg daily. Current serum potassium is 3.2 mEq/L. Vital signs: BP
110/70 mmHg, HR 64/min, RR 16/min.
QUESTION:
For which medication interaction is the client at risk with K⁺ = 3.2 mEq/L?
A. Toxic levels of furosemide
B. Toxic levels of digoxin
C. Subtherapeutic levels of furosemide
D. Subtherapeutic levels of digoxin
