Pharmacology Practice Quiz 2

Answer: C – Stop taking the drug and come to the clinic to be seen today

Explanation: Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.

Answer: A – Tachycardia

Explanation: Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease.

Answer: C – Lactic acidosis

Explanation: Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness.

Answer: D – Cardiac arrhythmias

Explanation: Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can induce seizures, but they are typically not life-threatening. TCAs do not cause an elevation in body temperature. TCAs do not cause metabolic acidosis.

Answer: A – 0.9 percent sodium chloride

Explanation: 0.9 percent sodium chloride is normal saline. This solution has the same osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are hypotonic solutions and can cause red cell lysis. The solution in option 4 may anticoagulate the patient and result in bleeding.

Answer: A – packed red blood cells

Explanation: Red blood cells contain antigens and antibodies that must be matched between donor and recipient. The blood products in options 2-4 do not contain red cells. Thus, they require no cross-match.

Answer: B – Graft-versus-host disease (GVHD)

Explanation: GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD.

Answer: D – Apheresis

Explanation: The process of apheresis involves removal of whole blood from a donor. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn, and the remaining components are retransfused into the donor. Directed donation is collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Autologous donation is the collection and reinfusion of the patient’s own blood. Allogeneic donation is collected from a blood donor other than the recipient.

Answer: D – The elderly above age 65 years

Explanation: People older than 65 years use 43 percent of donated blood. This number is expected to increase as the population ages.

Answer: D – “Granulocyte transfusions replenish the low white blood cells until the body can produce its own.”

Explanation: Granulocyte (neutrophil) replacement therapy is given until the patient’s blood values are normal and he is able to fight the infection himself. Options 1 and 3 are not therapeutic responses. The treatment in option 2 takes days and is not always able to prevent morbidity and mortality.