ATI RN
Proctored Pharmacology ATI
1. A client has a new prescription for Warfarin for atrial fibrillation. Which of the following findings should the nurse report to the provider immediately?
- A. INR of 4.0
- B. Potassium level of 4.5 mEq/L
- C. Sodium level of 140 mEq/L
- D. Creatinine level of 1.0 mg/dL
Correct answer: A
Rationale: An INR of 4.0 is above the therapeutic range for a client on Warfarin, indicating an increased risk of bleeding. This finding requires immediate reporting to the provider for appropriate intervention to prevent complications associated with excessive anticoagulation. Potassium, sodium, and creatinine levels are within normal ranges and are not directly related to the risk of bleeding in a client on Warfarin therapy.
2. A client with a urinary tract infection (UTI) is prescribed ciprofloxacin. Which instruction should the nurse provide to the client?
- A. If the medication causes an upset stomach, take an antacid at the same time.
- B. Increase your daily fluid intake while taking this medication.
- C. This medication can cause photophobia, so avoid direct sunlight exposure.
- D. You should report any tendon discomfort you experience while taking this medication.
Correct answer: D
Rationale: The correct answer is D. Tendon discomfort is a potential side effect of ciprofloxacin that can lead to tendon rupture and should be reported immediately to prevent serious complications. Monitoring for this adverse effect is crucial for patient safety. Choices A, B, and C are incorrect because: A) Taking an antacid with ciprofloxacin can interfere with its absorption. B) Increasing fluid intake is generally a good recommendation but not specifically related to the side effects of ciprofloxacin. C) Photophobia is not a common side effect of ciprofloxacin; therefore, avoiding direct sunlight exposure is not necessary.
3. 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.
4. 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.
5. A client has a new prescription for Levothyroxine to treat hypothyroidism. Which of the following instructions should be included in the teaching?
- A. Take this medication with food.
- B. Take this medication at bedtime.
- C. Expect to see results in 1 week.
- D. Do not discontinue the medication without consulting the provider.
Correct answer: D
Rationale: The correct instruction for a client with a new prescription for Levothyroxine to treat hypothyroidism is not to discontinue the medication without consulting the provider. Abrupt cessation could lead to the return of hypothyroid symptoms, emphasizing the importance of medical guidance when considering any changes to the treatment plan. Choice A is incorrect because Levothyroxine should be taken on an empty stomach, typically in the morning. Choice B is incorrect as it contradicts the timing of administration for Levothyroxine. Choice C is inaccurate as it usually takes a few weeks for the full effects of Levothyroxine to be seen, not just 1 week.
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