Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 72-year-old male with a history of
chronic heart failure is prescribed digoxin 0.125 mg orally
daily. During a home health visit, the patient reports
progressive anorexia, blurred vision with a yellowish haze,
and mild nausea over the past three days. The nurse notes
an irregular apical pulse of 52 beats per minute.
• Question Stem: Which action should the nurse take first?
o A. Administer the scheduled dose of digoxin and
document the vital signs.
o B. Instruct the patient to drink a glass of orange juice
to correct potential hypokalemia.
o C. Hold the digoxin dose and notify the primary
healthcare provider immediately.
o D. Advise the patient to rest for an hour and recheck
the pulse rate.
• Correct Answer: C
• Comprehensive Rationale: The patient is exhibiting classic
clinical manifestations of digoxin toxicity, which include
gastrointestinal disturbances (anorexia, nausea) and visual
changes (yellow-green halos or blurred vision), coupled
with profound bradycardia ($<$ 60 beats/min). Digoxin has
a narrow therapeutic index. Because the drug inhibits the
, sodium-potassium ATPase pump, toxicity can lead to life-
threatening dysrhythmias. Holding the medication
prevents further accumulation of the drug, and notifying
the provider ensures that a serum digoxin level and
electrolyte panel can be ordered immediately.
• Distractor Analysis:
o A is incorrect: Administering the dose would
exacerbate toxicity, risking fatal ventricular
arrhythmias.
o B is incorrect: While hypokalemia sensitizes the
myocardium to digoxin toxicity, empirical
administration of potassium via orange juice without
a confirmed serum level is unsafe and delays
definitive care.
o D is incorrect: Waiting and resting will not reverse
drug accumulation; delaying notification places the
patient at high risk for clinical deterioration.
• Nursing Process Integration: Implementation. The nurse
performs an immediate safety intervention (holding the
drug) based on critical assessment data. Assessment
provided the vital signs and symptoms; Planning involves
organizing interprofessional notification; Evaluation will
require monitoring the resolution of toxic symptoms and
laboratory values.
, • NCJMM Competency: Take Action
• Difficulty Level: Moderate
• Bloom's Cognitive Level: Apply
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Recognize clinical signs of narrow
therapeutic index drug toxicities and implement
appropriate restrictive safety protocols.
Question 2: Select-All-That-Apply (SATA)
• Clinical Scenario: A nurse is preparing an educational
session for a patient newly prescribed oral spironolactone
for the management of primary hypertension.
• Question Stem: Which instructions should the nurse
include in the teaching plan? Select all that apply.
o A. "Avoid using salt substitutes containing potassium
chloride."
o B. "Increase your intake of high-potassium foods like
bananas and spinach."
o C. "Report any new-onset muscle weakness,
cramping, or irregular heartbeats."
o D. "Take this medication right before bedtime to
maximize its effectiveness."
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 72-year-old male with a history of
chronic heart failure is prescribed digoxin 0.125 mg orally
daily. During a home health visit, the patient reports
progressive anorexia, blurred vision with a yellowish haze,
and mild nausea over the past three days. The nurse notes
an irregular apical pulse of 52 beats per minute.
• Question Stem: Which action should the nurse take first?
o A. Administer the scheduled dose of digoxin and
document the vital signs.
o B. Instruct the patient to drink a glass of orange juice
to correct potential hypokalemia.
o C. Hold the digoxin dose and notify the primary
healthcare provider immediately.
o D. Advise the patient to rest for an hour and recheck
the pulse rate.
• Correct Answer: C
• Comprehensive Rationale: The patient is exhibiting classic
clinical manifestations of digoxin toxicity, which include
gastrointestinal disturbances (anorexia, nausea) and visual
changes (yellow-green halos or blurred vision), coupled
with profound bradycardia ($<$ 60 beats/min). Digoxin has
a narrow therapeutic index. Because the drug inhibits the
, sodium-potassium ATPase pump, toxicity can lead to life-
threatening dysrhythmias. Holding the medication
prevents further accumulation of the drug, and notifying
the provider ensures that a serum digoxin level and
electrolyte panel can be ordered immediately.
• Distractor Analysis:
o A is incorrect: Administering the dose would
exacerbate toxicity, risking fatal ventricular
arrhythmias.
o B is incorrect: While hypokalemia sensitizes the
myocardium to digoxin toxicity, empirical
administration of potassium via orange juice without
a confirmed serum level is unsafe and delays
definitive care.
o D is incorrect: Waiting and resting will not reverse
drug accumulation; delaying notification places the
patient at high risk for clinical deterioration.
• Nursing Process Integration: Implementation. The nurse
performs an immediate safety intervention (holding the
drug) based on critical assessment data. Assessment
provided the vital signs and symptoms; Planning involves
organizing interprofessional notification; Evaluation will
require monitoring the resolution of toxic symptoms and
laboratory values.
, • NCJMM Competency: Take Action
• Difficulty Level: Moderate
• Bloom's Cognitive Level: Apply
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Recognize clinical signs of narrow
therapeutic index drug toxicities and implement
appropriate restrictive safety protocols.
Question 2: Select-All-That-Apply (SATA)
• Clinical Scenario: A nurse is preparing an educational
session for a patient newly prescribed oral spironolactone
for the management of primary hypertension.
• Question Stem: Which instructions should the nurse
include in the teaching plan? Select all that apply.
o A. "Avoid using salt substitutes containing potassium
chloride."
o B. "Increase your intake of high-potassium foods like
bananas and spinach."
o C. "Report any new-onset muscle weakness,
cramping, or irregular heartbeats."
o D. "Take this medication right before bedtime to
maximize its effectiveness."
