ATI RN
Proctored Pharmacology ATI
1. A client has been prescribed Nitroglycerin patches for angina. Which of the following instructions should the nurse include during discharge teaching?
- A. Apply the patch to a different site each time.
- B. Remove the patch for 12 hours each day.
- C. Apply the patch at the same time every day.
- D. Cut the patch in half if your blood pressure is well controlled.
Correct answer: B
Rationale: The correct answer is B: 'Remove the patch for 12 hours each day.' Nitroglycerin patches should be removed for 12 hours each day to prevent the development of tolerance. This nitrate-free interval ensures the medication remains effective in managing angina. Choice A is incorrect because applying the patch to a different site each time is not necessary; it is more important to ensure a nitrate-free interval. Choice C is incorrect because while consistency in timing is good for medication adherence, the crucial aspect for Nitroglycerin patches is the nitrate-free interval. Choice D is incorrect because cutting the patch in half based on blood pressure control is not a recommended practice and could alter the medication's efficacy.
2. Which drug undergoes extensive first-pass hepatic metabolism?
- A. Heparin
- B. Insulin
- C. Propranolol
- D. Nitroglycerin
Correct answer: C
Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.
3. When does regular insulin typically peak?
- A. 30 minutes to 2 ½ hours
- B. 1 to 3 hours
- C. 6 to 14 hours
- D. 1 to 5 hours
Correct answer: D
Rationale: Regular insulin usually peaks around 1 to 5 hours after administration. This peak time frame is important to consider when managing blood glucose levels and timing meals to coincide with insulin activity. Choice A, '30 minutes to 2 ½ hours,' is incorrect because regular insulin typically peaks later. Choice B, '1 to 3 hours,' is not the most accurate as the peak for regular insulin can extend beyond 3 hours. Choice C, '6 to 14 hours,' is incorrect as this timeframe is more indicative of long-acting insulins, not regular insulin.
4. A client has a prescription for Desmopressin for the treatment of Diabetes Insipidus. Which of the following instructions should the nurse include in the teaching?
- A. Decrease fluid intake at the start of treatment.
- B. Monitor for nocturia.
- C. Report a weight loss of 0.5 kg (1.1 lb) per week.
- D. Expect permanent polyuria with this medication.
Correct answer: A
Rationale: Desmopressin is a medication used to reduce diuresis in clients with diabetes insipidus. To prevent water intoxication, clients should be advised to decrease fluid intake at the beginning of treatment. This instruction helps to balance fluid levels in the body and prevent potential complications associated with excessive fluid intake while on Desmopressin therapy. Monitoring for signs of fluid retention, such as weight gain, and adjusting fluid intake accordingly are essential components of client education when initiating treatment with Desmopressin.
5. A client is starting a new prescription for furosemide. Which of the following instructions should the nurse include?
- A. Take the medication with food.
- B. Weigh yourself daily.
- C. Take potassium supplements as needed.
- D. Decrease intake of foods high in sodium.
Correct answer: B
Rationale: When a client is prescribed furosemide, it is important to monitor for fluid loss. Weighing oneself daily helps track changes in weight due to fluid loss, which can indicate the effectiveness of the medication. This monitoring assists in managing fluid balance and adjusting the dosage if necessary to achieve the desired therapeutic effect. Choice A is incorrect because furosemide is usually recommended to be taken on an empty stomach. Choice C is incorrect because potassium supplements should only be taken if prescribed by a healthcare provider due to the risk of hyperkalemia with furosemide. Choice D is incorrect because decreasing sodium intake is generally a good dietary practice but not a specific instruction related to furosemide therapy.
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