ATI PHARMACOLOGY (QUESTIONS) VERIFIED
ii ii ii
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ii ii ii ii ii
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ii ii ii
1-A iinurse iihas iicompleted iiteaching iia iiclient iiwho iiis iibeing iidischarged iion iilithium iifor iia iibipolar
iidisorder. iiWhich iistatement iiby iithe iiclient iiindicates iia iineed iifor iifurther iiteaching? ii
1. ii"I iineed iito iidrink ii1-2 iiliters iiof iifluid iidaily." ii
2. ii"I iineed iito iihave iimy iiblood iilevels iichecked iiperiodically." ii
3. ii"I iishould iinot iilimit iimy iisodium iiintake." ii
4. ii"I iishould iiuse iiibuprofen iifor iipain iirelief." ii
ii
Explanation: ii
Lithium iiis iia iimood iistabilizer iimost iioften iiused iito iitreat iibipolar iiaffective iidisorders. iiIt iihas iia iivery
iinarrow iitherapeutic iiserum iirange iiof ii0.6-1.2 iimEq/L ii(0.6-1.2 iimmol/L). iiLevels ii>1.5 iimEq/L ii(1.5
iimmol/L) iiare iiconsidered iitoxic. iiLithium iitoxicity iiusually iioccurs iiwith iithe iifollowing: ii
ii
1. Dehydration ii
2. Decreased iirenal iifunction ii(eg, iielderly iiclients) ii
3. Diet iilow iiin iisodium ii
4. Drug-drug iiinteractions ii(nonsteroidal iianti-inflammatory iidrugs ii[NSAIDs] iiand iithiazide
iidiuretics) ii
ii
Lithium iiis iicleared iirenally. iiEven iia iimild iichange iiin iikidney iifunction ii(as iiseen iiin iielderly iiclients)
iican iicause iiserious iilithium iitoxicity. iiTherefore, iidrugs iithat iidecrease iirenal iiblood iiflow ii(eg, iiNSAIDs)
iishould iibe iiavoided. iiAcetaminophen iiwould iibe iia iibetter iichoice iifor iipain iirelief ii(Option ii4). ii
(Options ii1 iiand ii3) iiSodium, iiwater, iiand iilithium iiare iinormally iifiltered iiby iithe iikidneys. iiRestriction
iiof iidietary iisodium/water iior iidehydration iisignals iirenal iisodium iiand iiwater iireabsorption iiwhich iiwill
iialso iiincrease iilithium iiabsorption, iiresulting iiin iitoxicity. iiTherefore, iiclients iishould iinever iirestrict iitheir
iisodium iior iiwater iiintake iiwhile iitaking iilithium; iiinstead, iithey iishould iimaintain iia iiconsistent iisodium
iiintake. ii
(Option ii2) iiBlood iishould iibe iidrawn iifrequently iito iimonitor iifor iitherapeutic iilithium iilevels iiand iitoxicity.
ii
Educational iiobjective: ii
Dehydration, iidecreased iirenal iifunction, iidiet iilow iiin iisodium, iiand iidrug-drug iiinteractions ii(eg, iiNSAIDs
iiand iithiazide iidiuretics) iican iicause iilithium iitoxicity. ii
ii
ii
2-A iiclient iiwith iicancer iipain iiis iiprescribed iioxycodone. iiWhich iiteaching iiis iimost iiessential iito iihelp
iiprevent iilong-term iicomplications? ii
1. iiTeach iithe iiclient iihow iito iiassess iiblood iipressure iidaily ii
2. iiTeach iithe iiclient iihow iito iiprevent iiconstipation ii
, lOMoAR ii cPSD| ii 2422086 6 ii
3. iiTeach iithe iiclient iihow iito iiprevent iiitching ii
, lOMoAR ii cPSD| ii 2422086 6 ii
ii
ii
4. iiTeach iithe iiclient iihow iito iiprevent iinausea ii
ii
Explanation: ii
Oxycodone iiis iia iimorphine-like iiopioid iimedication. iiOpioid iimedications iibind iito iiopioid iireceptors iiin
iithe iiintestine, iiwhich iislows iiperistalsis iiand iiincreases iiwater iiabsorption, iileading iito iiconstipation.
iiConstipation iiis iian iialmost iiuniversally iiexpected iiside iieffect iifrom iiopioid iimedications. iiClients iiwill
iinot iidevelop iitolerance iito iithis iiside iieffect. iiAlthough iiclients iiwith iiidiopathic iichronic iiconstipation
iiare iinot iicommonly iiadvised iito iitake iilaxatives, iiopioid-induced iiconstipation iiis iitreated iiwith
iisimultaneous iiuse iiof iisenna ii(stimulant) iiand iidocusate ii(stool iisoftener). ii
(Options ii1 iiand ii3) iiOpioids iicause iithe iirelease iiof iihistamine, iia iivasodilator, iiwhich iiis
iiresponsible iifor iipruritus iiand iiflushing. iiOpioids iican iialso iicause iiperipheral iivasodilation iiand
iinervous iisystem iidepression; iiboth iican iilead iito iihypotension. iiThese iidevelop iiin iisome iiclients
iiwhen iithe iitreatment iiis iiinitiated iibut iiusually iiresolve iiover iitime. iiAntihistamines ii(eg,
iidiphenhydramine) iican iiprevent iithe iipruritus. iiLifestyle iichanges ii(eg, iirising iislowly iifrom iia iiseated
iiposition) iiand iiadequate iihydration iican iiprevent iihypotension. ii
(Option ii4) iiOpioids iistimulate iithe iiopioid iireceptors iiin iithe iigastrointestinal iitract iiand iithe
iichemoreceptor iitrigger iizone iiin iithe iibrain, iiproducing iinausea. iiThis iiis iialso iinot iiseen iiwith iilong-term
iiuse. iiAntiemetics ii(eg, iiondansetron) iican iibe iihelpful. ii
Educational iiobjective: ii
Constipation iiis iian iiexpected iilong-term iiside iieffect iiof iiopioid iiuse; iiclients iiwill iinot iidevelop iitolerance
iito iithis iiside iieffect. iiIt iiis iiimportant iito iiteach iiaggressive iipreventive iimeasures ii(eg, iidefecate iiwhen
iithe iiurge iiis iifelt, iidrink ii2-3 iiL iiof iifluid/day, iihigh-fiber iidiet, iiexercise) iiand iisimultaneous iiuse iiof iia iistool
iisoftener iiand iia iistimulant. ii
ii
ii
3- iiThe iinurse iiis iireviewing iiprescriptions iifor iithe iiassigned iiclients. iiWhich iiprescriptions iishould iithe
ii nurse iiquestion? iiSelect iiall iithat iiapply. ii
1. iiAllopurinol iifor iia iiclient iiwho iideveloped iitumor iilysis iisyndrome iifrom iichemotherapy iifor
iiacute iileukemia ii
ii2. iiDicyclomine iifor iia iiclient iiwith iia iihistory iiof iiirritable iibowel iisyndrome iiwho iidevelops iia
iipostoperative iiparalytic iiileus ii
3. iiIV iimorphine iifor iia iiclient iiwith iisevere iiacute iirenal iicolic iipain iiwho iiis iischeduled iifor iia
iipercutaneous iinephrolithotripsy ii
ii4. iiLevofloxacin iifor iia iiclient iiwith iia iiurinary iitract iiinfection iiwho iihas iia iihistory iiof iianaphylaxis iito
iipenicillin iidrugs ii
5. iiSimvastatin iifor iia iiclient iiwith iihypercholesterolemia iiwho iiis iireporting
ii
iigeneralized iimuscle iiaches iiand iiweakness iiExplanation: ii
The iinurse iishould iiquestion iithese iiprescriptions iiand iicontact iithe iihealth iicare iiprovider: ii
, lOMoAR ii cPSD| ii 2422086 6 ii
ii
• Dicyclomine, iian iianticholinergic/antispasmodic iidrug iiprescribed iito iimanage iiirritable
iibowel iisyndrome, iiis iicontraindicated iiwith iiparalytic iiileus, iias iiit iidecreases iiintestinal
iimotility iiand iiwould iiexacerbate iithe iicondition ii(Option ii2). ii
• Statins ii(eg, iiatorvastatin, iisimvastatin) iilower iiLDL iicholesterol. iiMyopathy, iia iipossible
iiadverse iieffect, iimay iilead iito iilife-threatening iirhabdomyolysis ii(Option ii5). ii
ii
(Option ii1) iiTumor iilysis iisyndrome iiis iidue iito iirapid iilysis iiof iicells iiand iithe iiresulting iirelease iiof
iiintracellular iiions iipotassium iiand iiphosphorous iiinto iiserum. iiPhosphorus iibinds iicalcium iiand iicauses
iihypocalcemia. iiMetabolism ii(catabolism) iiof iireleased iicellular iinucleic iiacids iileads iito iisevere
iihyperuricemia. iiIV iihydration iiand iihypouricemic iimedications ii(eg, iiallopurinol) iiare iiusually iiprescribed
iito iipromote iiexcretion iiof iipurines iiand iiprevent iiacute iikidney iiinjury. ii
(Option ii3) iiIV iiopioids ii(eg, iimorphine) iior iinonsteroidal iianti-inflammatory iiagents ii(eg, iiketorolac) iiare
iiused iito iitreat iisevere iirenal iicolic iipain. iiPercutaneous iinephrolithotripsy iibreaks iiand iiremoves iistones
iiand iican iilead iito iisevere iipain. iiTherefore, iipain iimedications iiare iiappropriate. ii
(Option ii4) iiLevofloxacin, iia iifluoroquinolone iiantibiotic iiprescribed iito iitreat iiurinary iitract iiinfections,
iihas iino iiknown iicross-sensitivity iito iipenicillin. iiHowever, iicross-sensitivity iiwith iiother
iifluoroquinolones iican iioccur. ii
Educational iiobjective: ii
Dicyclomine iiis iian iiantispasmodic iidrug iithat iidecreases iiintestinal iimotility iiand iiis iicontraindicated iiwith
iiparalytic iiileus. iiFor iiclients iiwith iimyopathy, iistatins iishould iibe iiwithheld iiand iithe iihealth iicare iiprovider
iicalled. iiPrior iito iiand iiduring iichemotherapy, iiallopurinol iihelps iiprevent iihyperuricemia iiin iiclients iiat iirisk
iifor iitumor iilysis iisyndrome. ii
ii
4- iiWhich iiclient iiis iiat iigreatest iirisk iifor iirespiratory iidepression iiwhen iireceiving iiopioids iifor iipain
ii control? ii
1. ii20-year-old iiclient iiwith iibronchitis iireceiving iiinhaled iibronchodilator iitherapy iievery ii4 iihours ii
2. ii30-year-old iiclient iiwith iiheroin iiaddiction iiwith iirotator iicuff iirepair iisurgery iithis iimorning ii
3. ii50-year-old iiclient iiwith iisleep iiapnea iiand iileft iifoot iicellulitis iiand iischeduled iifor iia iibone iiscan ii
4. ii70-year-old iiclient iiwith iichronic iiobstructive iipulmonary iidisease ii(COPD) iiwith
ii
iiknee iireplacement iithis iimorning iiExplanation: ii
The iifollowing iiare iiat iigreatest iirisk iifor iirespiratory iidepression iirelated iito iiopioid iiuse iifor iianalgesia:
iithe iielderly; iithose iiwith iiunderlying iipulmonary iidisease, iihistory iiof iisnoring ii(with iior iiwithout iiapnea),
iiobesity, iior iismoking ii(more iithan ii20-pack-year iihistory); iithe iiopiate iinaïve, iiespecially iiif iitreated iifor
iiacute iipain; iiand iipost iisurgery ii(first ii24 iihours). ii
The ii70-year iiold iiclient iihas ii3 iisignificant iirisk iifactors: iiadvanced iiage, iiCOPD, iiand iisurgery iiwithin
ii24 iihours. iiCOPD iiclients iiwho iihave iihypercarbia iiand iihypoxemia iiare iiat iieven iigreater iirisk iifor
iirespiratory iidepression iiwhen iireceiving iiopioids. ii
(Option ii1) iiThis iiclient iihas ii1 iirisk iifactor, iipulmonary iidisease. ii