Pharmacology Bowl

NSG 452: Pharmacology Bowl

by Ginny Bayes

Multiple Choice

The nurse is caring for a client with systemic candidiasis who is receiving amphotericin B intravenously. The nurse would perform which action during administration of the medication to monitor for an adverse effect?

• Monitor urinary output

• Check peripheral pulses

• Monitor for hypothermia

• Check the neurological status

​Pharmacology Fact: because amphotericin B can cause such serious side effects it should only be used to treat life threatening fungal infections and leishmaniasis

Multiple Choice

A client with arthritis is taking OTC aspirin for pain control. The nurse recognizes which finding as an adverse effect related to the medication?

• Tinnitus

• Joint pain

• Urinary retention

• Difficulty voiding

​Pharmacology Fact: aspirin overdose results in an elevated anion gap metabolic acidosis

Multiple Choice

Theophylline is prescribed for a client with bronchial asthma. The nurse provides dietary instructions to the client and would tell the client to avoid consuming which item?

• Iced tea

• Lemonade

• Orange juice

• Tomato juice

​Pharmacology fact: theophylline has an extremely narrow therapeutic window and overdoses are common causing life threatening arrythmias & seizures

Multiple Choice

The nurse is providing instructions to a client about lithium carbonate, which has been prescribed for acute mania. The nurse would provide which information to the client?

• Foods that contain salt need to be avoided

• Medication blood levels need to be checked yearly

• Vomiting and diarrhea are expected side effects of the medication

• Blurred vision needs to be reported to the primary health care provider

Multiple Choice

A client with acute kidney injury has been treated with sodium polystyrene sulfonate by mouth. The nurse would evaluate this therapy as most effective if which value was noted on follow-up laboratory testing?

• Calcium 9.8 mg/dL

• Sodium 142 mEq/L

• Potassium 4.9 mEq/L

• Phosphorus 3.9 mg/dL

​Bonus Question: what is a contraindication to the

administration of this medication?

Multiple Choice

Betaxolol eye drops have been prescribed for a client for the treatment of glaucoma. The nurse would instruct the client that it is important to return to the clinic for assessment of the presence of which condition?

• Hypotension

• Hyperglycemia

• The presence of Trousseau's sign

• The presence of redness and warmth in the calf area

Multiple Select

The nurse is caring for a client with a diagnosis of venous thrombosis in the left lower leg who is receiving heparin sodium by continuous IV infusion. The nurse would monitor the client for which manifestations indicating an adverse effect of this therapy? Select all that apply.

• Nausea

• Dark urine

• Left calf tenderness

• Decreased platelet count

• Headache and ataxia

​Pharmacology Fact: long term heparin use can cause heparin-induced osteopenia

Multiple Choice

The nurse at the clinic is providing new medication teaching for a 30 year old male patient recently diagnosed with gout and placed on allopurinol. Which of the following statements, if made by the patient, would warrant further teaching?

• "I know my diet needs to change but I'm glad I can still have my nightly beers."

• "I am sure going to miss my liver and onions."

• "I will incorporate more poultry into my diet as a substitute for red meat."

• "I will start taking a vitamin C supplement daily."

​Pharmacology Fact: during the initial few months of allopurinol therapy patients are more prone to acute gouty flares, this can be potentially avoided with anti-inflammatory therapy with an NSAID or colchicine.

​Answer: 1. Alcohol is contraindicated in patients with gout for two reasons: any type of alcohol can cause gout flare ups but beer appears to be worse than other types of alcohol as it contains more purines; allopurinol can be hepatotoxic with asymptomatic elevation of liver enzymes seen in some patients. Liver enzymes are monitored every 2-5 weeks initially during drug titration then every 6 months after that.

Multiple Choice

The client with acquired immunodeficiency syndrome and Pneuomocystis jiroveci infection has been receiving pentamidine. The client develops a temperature of 101 F (38.3 C). The nurse continues to assess the client, knowing that this sign most likely indicates which condition?

• That the dose of the medication is too low

• That the client is experiencing toxic effects of the medication

• The the client has developed inadequacy of thermoregulation

• That the client has developed another infection caused by leukopenic effects of the medication

​Pharmacology Fact: pentamidine (NebuPent) is an anti-infective agent used to treat P. jiroveci; it is administered by the inhalation route via a nebulizer. It is usually administered about every 4 weeks.

Multiple Choice

A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

• Fever

• Sores in the mouth and throat

• Complaints of nausea and vomiting

• Crackles on auscultation of the lungs

​Hard Question Hangover: side effect vs adverse effect

​Side effect: could be a negative side effect or possibly a positive side effect. i.e. it is an expected side effect that a loop diuretic causes hypokalemia or i.e. minoxidil was marketed as an antihypertensive but it was discovered that it caused hair growth so it was remarketed as a hair growth stimulant.

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Adverse effect: always negative, not expected. i.e. heart failure as a result of chemotherapy or rhabdomyolysis as a result of statin therapy.

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This question is difficult if the student is not clear regarding ​side effect versus adverse effect because all of the answer choices are unfortunate results of chemotherapy, 3 are side effects and 1 is an adverse effect.