D441 Medical Dosage Calculations and Pharmacology - Set 2 - Part 3

Correct Answer: Hepatotoxicity presenting with jaundice and pain

Statins can cause hepatotoxicity characterized by right upper quadrant pain, fatigue, and jaundice from liver inflammation. These findings prompt immediate liver enzyme assessment and likely statin discontinuation to prevent further hepatic damage. Option a is incorrect because rhabdomyolysis presents with severe widespread muscle pain and cola-colored urine from myoglobin release, not jaundice or right-sided abdominal discomfort. This profile specifically indicates liver involvement. Option b is incorrect because nephrotoxicity presents with declining kidney function and changes in urine output. It does not cause skin jaundice or right upper quadrant pain, which are liver-specific findings indicating hepatic involvement. Option c is incorrect because Red Man Syndrome is an infusion-related reaction to intravenous vancomycin involving flushing and rash. Statins are oral medications and do not cause Red Man Syndrome.

Correct Answer: Voiding adequately with non-distended soft abdomen

Bethanechol stimulates cholinergic receptors to contract the detrusor bladder muscle. Therapeutic success is confirmed by the patient voiding at least 30 mL per hour with a soft, non-distended bladder on abdominal assessment. Option b is incorrect because bethanechol acts on bladder smooth muscle through cholinergic stimulation and does not directly regulate blood pressure or manage pain. Blood pressure normalization is not a monitoring indicator for bethanechol. Option c is incorrect because bethanechol may cause bradycardia as a side effect, but heart rate reduction is not the therapeutic goal. Successful bladder emptying with adequate urine output confirms the medication is working as intended. Option d is incorrect because return of bowel sounds indicates GI motility recovery, not bladder function restoration. The primary therapeutic endpoint for bethanechol is successful bladder emptying and decompression, not GI function.

Correct Answer: Tetrabenazine to reduce involuntary facial movements

Tetrabenazine is specifically used to treat tardive dyskinesia by depleting monoamines and reducing the involuntary repetitive movements caused by long-term dopamine receptor blockade from antipsychotic medications. Option a is incorrect because lithium is a mood stabilizer used for bipolar disorder and schizoaffective conditions. It does not treat tardive dyskinesia or address the dopamine receptor hypersensitivity underlying involuntary movement from antipsychotic drug exposure. Option b is incorrect because levodopa increases dopamine and is used for Parkinson's disease. Tardive dyskinesia involves excess dopamine receptor sensitivity from chronic blockade, making levodopa potentially worsening for involuntary movements. Option d is incorrect because naloxone is an opioid antagonist used to reverse opioid toxicity. It has no pharmacological mechanism for reversing dopamine receptor changes associated with antipsychotic-induced tardive dyskinesia.

Correct Answer: Expected anticholinergic effects; reassure the patient

Scopolamine is an anticholinergic medication. Dry mouth, drowsiness, and mild blurred vision are expected anticholinergic side effects from muscarinic receptor blockade and do not require intervention beyond patient reassurance and monitoring. Option a is incorrect because dry mouth, drowsiness, and blurred vision are not opioid side effects. Opioids typically cause nausea, constipation, and respiratory depression. These symptoms reflect the anticholinergic mechanism of scopolamine. Option c is incorrect because anticholinergic side effects like dry mouth and drowsiness are expected with scopolamine and do not indicate allergic reaction. True allergy would present with urticaria, angioedema, or respiratory distress. Option d is incorrect because dry mouth, mild drowsiness, and slight visual blurring are known and anticipated side effects of scopolamine therapy. These do not represent overdose and do not warrant emergency antidote administration.

Correct Answer: Known non-therapeutic side effects of minoxidil

Hair growth caused by hypertrichosis and fluid retention from increased sodium and water retention are documented non-therapeutic outcomes of minoxidil. They are expected side effects unrelated to the drug's intended antihypertensive benefit. Option a is incorrect because hair growth and fluid retention are not signs of minoxidil toxicity. They are predictable, well-documented non-therapeutic pharmacological side effects that do not indicate dangerous drug accumulation. Option b is incorrect because therapeutic outcomes of minoxidil are blood pressure reduction below 130/80 mmHg and improved renal function. Hair growth and fluid retention are classified as non-therapeutic side effects. Option c is incorrect because hypertrichosis and fluid retention are not immune-mediated allergic responses to minoxidil. They result from the drug's pharmacological vasodilating mechanism affecting hair follicles and sodium retention.

Correct Answer: Hold digoxin and notify provider immediately

Hypokalemia significantly increases digoxin toxicity risk. A potassium of 3.1 mEq/L is below the normal range, sensitizing cardiac tissue to digoxin effects. The nurse holds the dose and notifies the provider before administration. Option a is incorrect because a potassium of 3.1 mEq/L is below the normal range and unsafe before digoxin. Low potassium sensitizes cardiac cells to digoxin toxicity even at normally therapeutic drug concentrations. Option c is incorrect because increasing digoxin when potassium is low would drastically worsen toxicity risk. Low potassium amplifies digoxin's cardiac effects and could trigger life-threatening arrhythmias at a higher dose. Option d is incorrect because independently replacing potassium and then giving digoxin without provider notification is outside nursing scope. The provider must direct both electrolyte correction and the timing of digoxin administration.

Correct Answer: Give sucralfate separate from other medications

Sucralfate blocks the absorption of most other medications taken simultaneously. It must be given one to two hours before or after other drugs and on an empty stomach to preserve drug absorption and ulcer protection. Option a is incorrect because taking sucralfate with other medications allows it to bind to and block their absorption, reducing their effectiveness. Sucralfate must be taken separately with adequate time before or after other medications. Option b is incorrect because sucralfate must be taken on an empty stomach, not with food. Food reduces the drug's ability to adhere directly to the ulcer. Taking sucralfate with breakfast prevents proper mucosal binding. Option d is incorrect because taking sucralfate after all other medications may still result in drug interaction if prior medication absorption was not complete. The one to two hour separation window applies in both directions for safety.

Correct Answer: Administer glucagon IM or SUBQ now

An unconscious patient with critically low blood glucose cannot take oral medications safely. The glucagon emergency kit is administered intramuscularly or subcutaneously to rapidly raise blood glucose in unresponsive hypoglycemic patients. Option b is incorrect because oral carbohydrates cannot be safely given to an unconscious patient due to aspiration risk. Liquids or food given orally to an unresponsive patient can be inhaled into the lungs, creating a life-threatening emergency. Option c is incorrect because while IV dextrose is the clinical standard for severe hypoglycemia, the glucagon kit is immediately available and appropriate for rapid use. IV access insertion adds unnecessary delay when glucagon is present. Option d is incorrect because calling the rapid response team should occur simultaneously with or after glucagon administration. Delaying intervention prolongs the dangerous hypoglycemic state and increases the risk of irreversible brain damage.

Correct Answer: Slow infusion rate for Red Man Syndrome

Itching, red rash across the face and upper body, and hypotension occurring early in vancomycin infusion indicate Red Man Syndrome. The priority action is slowing or stopping the infusion rate and reassessing symptoms closely. Option a is incorrect because epinephrine is indicated for true anaphylaxis, characterized by tachycardia, angioedema, and wheezing. While hypotension is present, the rash pattern and early infusion timing are more consistent with Red Man Syndrome. Option b is incorrect because Red Man Syndrome symptoms including flushing, rash, itching, and hypotension require immediate infusion rate reduction. Continuing at the same rate will worsen histamine release and hemodynamic instability. Option c is incorrect because ototoxicity causes inner ear damage manifesting as tinnitus and hearing loss, not rash, itching, or hypotension. This presentation reflects an infusion-rate-related histamine-mediated reaction.

Correct Answer: Unusual bruising or blood in urine

Warfarin's primary complication is bleeding. Patients must immediately report unusual bruising, blood in urine or stool, prolonged bleeding from cuts, or gum bleeding, as these indicate dangerously elevated anticoagulation requiring prompt INR assessment. Option a is incorrect because mild headache after physical exertion is not a warfarin-specific complication. Headache alone is not urgent, though a sudden severe worst-ever headache could indicate intracranial bleeding requiring urgent evaluation. Option c is incorrect because increased appetite and weight gain are not associated with warfarin therapy. These findings may suggest other metabolic conditions but are not signs of anticoagulation-related complications requiring urgent clinical assessment. Option d is incorrect because mild stomach discomfort after oral warfarin is not an urgent concern requiring clinic contact. This minor GI symptom does not indicate bleeding or dangerous anticoagulation levels.