Select All That Apply Practice Test #2: Pharmacology and Medication Safety

Correct answers (A, C, E):
A. Take the tablet first thing in the morning, before any food or other medicine, with a full glass of plain water.
C. Stay sitting up or standing after taking the tablet, and do not lie down until after the first food of the day.
E. Report new heartburn, pain or trouble swallowing, or pain behind the breastbone.

Rationale: Alendronate is a bisphosphonate that is poorly absorbed and can irritate the esophagus. It is taken first thing in the morning on an empty stomach with a full glass of plain water (A). The client stays upright and waits before eating, drinking anything other than water, or taking other medicines; the product label says how long, usually at least 30 minutes (C). New heartburn, pain or trouble swallowing, or pain behind the breastbone can mean esophageal irritation or ulcers and should be reported (E). Option B is wrong because juice, coffee and other drinks greatly reduce absorption; only plain water is used. Option D is wrong because calcium, antacids and other minerals bind the drug; they are taken later in the day as directed. The provider decides on calcium and vitamin D intake.

Correct answers (B, C, D):
B. Brush and floss your teeth every day and see your dentist regularly.
C. Do not stop taking this medicine suddenly, even if you have had no seizures.
D. Report any skin rash to your provider right away.

Rationale: Phenytoin can cause overgrowth of the gums (gingival hyperplasia), so good daily oral hygiene and regular dental care help prevent it (B). Stopping an antiseizure medicine suddenly can trigger seizures, including status epilepticus, so any change is made by the provider (C). A rash can be the first sign of a serious skin reaction such as Stevens-Johnson syndrome, so it is reported right away (D). Option A is wrong because swollen gums are managed with oral care and reported to the provider; the client does not stop the drug on their own. Option E is wrong because phenytoin has a narrow therapeutic range, and levels are checked on the schedule the provider sets, not only after a seizure. Signs such as unsteady walking, double vision, rapid eye movements (nystagmus) or slurred speech can mean the level is too high and should be reported. Phenytoin can also make hormonal birth control less effective, so the client should ask about other methods.

Correct answers (B, D, E):
B. Report muscle weakness or a slow or irregular heartbeat.
D. Keep appointments for blood tests that check potassium and kidney function.
E. Breast tenderness or enlargement can happen; tell your provider if it occurs.

Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone blocker, so the main risk is a high potassium level (hyperkalemia). Muscle weakness and a slow or irregular heartbeat can be signs of high potassium and are reported (B). Potassium and kidney function are checked on the schedule the provider sets, because kidney problems and other medicines, such as ACE inhibitors, raise the risk (D). The drug can cause breast tenderness or enlargement (gynecomastia), which should be reported (E). Option A is wrong because most salt substitutes contain potassium chloride and can push potassium too high. Option C is wrong because potassium supplements are not taken unless the provider prescribes them; this drug holds potassium in the body.

Correct answers (A, B, D):
A. Stop the infusion right away.
B. Leave the catheter in place for now and try to draw back the drug through it, as the facility protocol directs.
D. Notify the provider and follow the facility's extravasation protocol for any antidote and for cold or warm compresses.

Rationale: A vesicant is a drug that can blister and destroy tissue if it leaks out of the vein (extravasation). The nurse stops the infusion at once (A). Following oncology nursing guidance and facility protocol, the tubing is disconnected and the nurse tries to draw back (aspirate) any remaining drug through the catheter before removing it (B). The provider is notified, and the protocol is followed for any antidote and for compresses (D). Whether cold or warm compresses are used depends on the drug, so the nurse checks the protocol rather than guessing. The nurse also elevates the limb, marks or photographs the area, documents, and keeps checking the site. Option C is wrong because flushing pushes more of the drug into the tissue. Option E is wrong because pressure and massage spread the drug and increase tissue damage.

Correct answers (A, C, E):
A. IV hydromorphone
C. Subcutaneous insulin
E. Concentrated potassium chloride for injection

Rationale: The ISMP high-alert list for acute care includes opioids such as IV hydromorphone (A), all forms of insulin (C), and concentrated potassium chloride for injection (E). Other examples are IV anticoagulants such as heparin, neuromuscular blocking agents and chemotherapy. Errors with these drugs are not always more common, but when they happen they are more likely to cause severe harm, so facilities add safeguards such as standard concentrations, smart pumps and independent double checks; follow facility policy. Options B and D are wrong because oral docusate and oral acetaminophen are not on the ISMP high-alert list, although every medication still needs the usual checks, and the total daily acetaminophen dose must be watched.

Correct answers (B, C, E):
B. Keep checking breathing, oxygen saturation and level of alertness closely.
C. Be ready to give another dose per protocol if breathing slows again.
E. Watch for withdrawal signs such as agitation, sweating, vomiting and the return of pain.

Rationale: Naloxone often wears off before the opioid does, especially with long-acting or extended-release opioids, so the client can become sedated and stop breathing well again. The nurse keeps monitoring breathing, oxygen saturation and alertness (B) and is ready to give more naloxone per protocol or prescription (C). Naloxone can cause sudden withdrawal and the return of pain, so the nurse watches for agitation, sweating, vomiting, fast heart rate and pain and reports them (E). Option A is wrong because the client must not be left unmonitored. Option D is wrong because giving more opioid could cause the overdose to return; pain and withdrawal are managed with the provider, who may adjust the plan. The event is documented and the cause of the overdose is reviewed.

Correct answers (A, C, D):
A. Remove the old patch and clean the skin before applying the new one.
C. Wear gloves while handling the patch.
D. Apply the patch to a clean, dry, hairless area and rotate sites.

Rationale: Removing the old patch and cleaning off leftover drug prevents a double dose and low blood pressure (A). Gloves keep the nurse from absorbing the drug through the skin, which can cause headache and low blood pressure in the nurse (C). Clean, dry, hairless skin helps the patch stick and absorb evenly, and rotating sites reduces skin irritation (D). If hair is in the way, it is clipped, not shaved, to avoid nicking the skin. Option B is wrong because patches are not cut unless the product label allows it; cutting can change the dose. Headache is a common side effect and is reported; the provider decides on dose changes. Option E is wrong because using the same spot can irritate the skin. Many plans include a daily patch-free period to prevent tolerance; the timing is set by the provider.

Correct answers (A, B, D):
A. Assess the airway and breathing right away and stay with the client.
B. Hold the lisinopril and call the rapid response team or provider.
D. Document the reaction and report it so ACE inhibitors are avoided in the future.

Rationale: Swelling of the lips, tongue and throat in a client taking an ACE inhibitor is angioedema. It can block the airway quickly, so the nurse assesses the airway and breathing and stays with the client (A). The drug is held and help is called right away, because the client may need airway support (B). The reaction is documented and reported so that ACE inhibitors are not given again (D). ACE inhibitor angioedema can happen at any time, even after years of use, and it is more common in Black clients. Option C is wrong because angioedema is a medical emergency, not a harmless side effect. Option E is wrong because the drug must not be given again. ACE inhibitor angioedema is driven by bradykinin, not histamine, so antihistamines often do not work well; treatment is directed by the provider.

Correct answers (A, C, D, E):
A. Severe abdominal pain
C. Chest pain or shortness of breath
D. Severe headache or changes in vision
E. Severe pain or swelling in one leg

Rationale: The warning signs are often taught with the memory aid ACHES: Abdominal pain (A), Chest pain or shortness of breath (C), Headaches that are severe (D), Eye problems such as blurred or lost vision (D), and Severe leg pain or swelling (E). These can be signs of blood clots, stroke, heart attack, liver problems or gallbladder disease, which are rare but serious risks of estrogen-containing pills. Smoking raises the risk of clots and heart problems, especially at age 35 and older. Option B is wrong because light breakthrough bleeding is common in the first few months and usually gets better; the client can report it at a routine visit if it continues.

Correct answers (B, C, D):
B. Take the stool softener and laxative as prescribed, starting when you start the opioid.
C. Drink plenty of fluids unless you have been told to limit them.
D. Walk and stay as active as you are allowed.

Rationale: Opioids slow the bowel, and constipation is one of their most common side effects. The bowel plan is started with the opioid, often a stimulant laxative with or without a stool softener, as prescribed (B). Fluids (C), fiber in the diet as tolerated, and walking or other activity (D) also help. Option A is wrong because, unlike nausea or sleepiness, the body usually does not become tolerant to opioid constipation; it lasts as long as the opioid is taken. Option E is wrong because the client should not stop pain medicine on their own; the client calls the provider if there is no bowel movement for the time the provider set, or if there is belly pain, swelling or vomiting, which could mean a blockage.