Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: Multiple-Choice Question (MCQ)
Clinical Scenario:
A 72-year-old female patient with chronic heart failure is
admitted to the medical-surgical unit. Her current home
medications include digoxin 0.25 mg daily, furosemide 40 mg
daily, and lisinopril 10 mg daily. The admitting provider orders a
new medication: ciprofloxacin 500 mg orally twice daily for a
urinary tract infection. The patient's laboratory results show
serum creatinine 1.8 mg/dL and BUN 32 mg/dL.
Question Stem:
The nurse identifies that the patient is at increased risk for
which medication-related complication due to the
pharmacokinetic changes associated with aging and the
addition of ciprofloxacin?
Answer Options:
A. Decreased digoxin absorption leading to subtherapeutic
levels
B. Increased digoxin toxicity due to decreased renal clearance
and drug interaction
C. Enhanced furosemide efficacy due to synergistic effects with
ciprofloxacin
D. Reduced ciprofloxacin effectiveness due to impaired hepatic
metabolism
,Correct Answer: B
Comprehensive Rationale:
The correct answer is B because this patient is at significant risk
for digoxin toxicity due to the convergence of multiple
pharmacokinetic risk factors. The patient's age (72 years) is
associated with physiological changes in drug distribution,
metabolism, and excretion. Age-related reduction in renal
function, evidenced by elevated serum creatinine (1.8 mg/dL)
and BUN (32 mg/dL), impairs the renal excretion of digoxin,
which is primarily eliminated unchanged by the kidneys. The
addition of ciprofloxacin creates a critical drug interaction:
fluoroquinolones such as ciprofloxacin can increase serum
digoxin concentrations by reducing renal clearance and
potentially displacing digoxin from tissue binding sites.
Furthermore, ciprofloxacin may alter gastrointestinal flora,
affecting digoxin metabolism in susceptible patients. The
patient's baseline heart failure creates a narrow therapeutic
window for digoxin, making toxicity more likely even with
modest increases in serum levels. The nurse must monitor for
signs of digoxin toxicity including nausea, vomiting, visual
disturbances (halos around lights), and cardiac dysrhythmias.
Distractor Analysis:
Option A: Incorrect. This represents a misunderstanding of
digoxin absorption. Digoxin absorption is not decreased by
, ciprofloxacin; rather, the interaction increases serum
concentrations. The misconception may arise from confusing
this interaction with medications that affect gastrointestinal
motility or absorption mechanisms. Clinically, this error could
lead to failure to monitor for toxicity and inappropriate dosing
adjustments.
Option C: Incorrect. There is no pharmacodynamic synergy
between furosemide and ciprofloxacin. This distractor appeals
to the common misconception that all drug combinations with
similar indications are synergistic. The clinical risk is that the
nurse might inappropriately adjust diuretic therapy without
recognizing the primary toxicity concern with digoxin.
Option D: Incorrect. Ciprofloxacin is primarily eliminated
through renal excretion, not hepatic metabolism. While the
drug undergoes some metabolism, the major route of
elimination is renal. This misconception may arise from
confusing ciprofloxacin with other medications metabolized by
the liver. The clinical error would be focusing monitoring on
hepatic function rather than renal function and digoxin levels.
Nursing Process Integration:
Primary Component: Assessment
The nurse must conduct a comprehensive assessment including
medication reconciliation, renal function evaluation, and
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: Multiple-Choice Question (MCQ)
Clinical Scenario:
A 72-year-old female patient with chronic heart failure is
admitted to the medical-surgical unit. Her current home
medications include digoxin 0.25 mg daily, furosemide 40 mg
daily, and lisinopril 10 mg daily. The admitting provider orders a
new medication: ciprofloxacin 500 mg orally twice daily for a
urinary tract infection. The patient's laboratory results show
serum creatinine 1.8 mg/dL and BUN 32 mg/dL.
Question Stem:
The nurse identifies that the patient is at increased risk for
which medication-related complication due to the
pharmacokinetic changes associated with aging and the
addition of ciprofloxacin?
Answer Options:
A. Decreased digoxin absorption leading to subtherapeutic
levels
B. Increased digoxin toxicity due to decreased renal clearance
and drug interaction
C. Enhanced furosemide efficacy due to synergistic effects with
ciprofloxacin
D. Reduced ciprofloxacin effectiveness due to impaired hepatic
metabolism
,Correct Answer: B
Comprehensive Rationale:
The correct answer is B because this patient is at significant risk
for digoxin toxicity due to the convergence of multiple
pharmacokinetic risk factors. The patient's age (72 years) is
associated with physiological changes in drug distribution,
metabolism, and excretion. Age-related reduction in renal
function, evidenced by elevated serum creatinine (1.8 mg/dL)
and BUN (32 mg/dL), impairs the renal excretion of digoxin,
which is primarily eliminated unchanged by the kidneys. The
addition of ciprofloxacin creates a critical drug interaction:
fluoroquinolones such as ciprofloxacin can increase serum
digoxin concentrations by reducing renal clearance and
potentially displacing digoxin from tissue binding sites.
Furthermore, ciprofloxacin may alter gastrointestinal flora,
affecting digoxin metabolism in susceptible patients. The
patient's baseline heart failure creates a narrow therapeutic
window for digoxin, making toxicity more likely even with
modest increases in serum levels. The nurse must monitor for
signs of digoxin toxicity including nausea, vomiting, visual
disturbances (halos around lights), and cardiac dysrhythmias.
Distractor Analysis:
Option A: Incorrect. This represents a misunderstanding of
digoxin absorption. Digoxin absorption is not decreased by
, ciprofloxacin; rather, the interaction increases serum
concentrations. The misconception may arise from confusing
this interaction with medications that affect gastrointestinal
motility or absorption mechanisms. Clinically, this error could
lead to failure to monitor for toxicity and inappropriate dosing
adjustments.
Option C: Incorrect. There is no pharmacodynamic synergy
between furosemide and ciprofloxacin. This distractor appeals
to the common misconception that all drug combinations with
similar indications are synergistic. The clinical risk is that the
nurse might inappropriately adjust diuretic therapy without
recognizing the primary toxicity concern with digoxin.
Option D: Incorrect. Ciprofloxacin is primarily eliminated
through renal excretion, not hepatic metabolism. While the
drug undergoes some metabolism, the major route of
elimination is renal. This misconception may arise from
confusing ciprofloxacin with other medications metabolized by
the liver. The clinical error would be focusing monitoring on
hepatic function rather than renal function and digoxin levels.
Nursing Process Integration:
Primary Component: Assessment
The nurse must conduct a comprehensive assessment including
medication reconciliation, renal function evaluation, and
