NR 293 Quiz 3

Student Name

Chamberlain University

NR-293: Pharmacology for Nursing Practice

Prof. Name

Date

Quiz 3: Pharmacology Review

Patient Concern: Black Bowel Movements After Iron Tablets

A patient contacts the clinic three days after starting oral iron supplements and expresses concern about experiencing black stools.

Question: What should the nurse do?

Answer: The nurse should explain that black stools are an expected and normal side effect of iron supplementation. This occurs due to unabsorbed iron oxidizing in the gastrointestinal tract, which darkens stool color. The nurse should reassure the patient that this does not indicate bleeding or other pathology. The patient should continue taking the medication as prescribed unless they experience other concerning symptoms such as severe abdominal pain or blood mixed with stool (Rosenthal & Burchum, 2021).

Epoetin Alfa Therapy in Chronic Renal Failure

Connie, a 58-year-old patient with chronic renal failure, is prescribed epoetin alfa (Epogen) due to profound fatigue caused by anemia.

Question: What is most important to monitor during epoetin alfa therapy?

Answer: The nurse must carefully monitor hemoglobin and hematocrit levels. Rapid increases in hemoglobin or values above 12 g/dL can significantly increase the risk of complications such as hypertension, stroke, or seizures. Dose adjustments should be guided by these lab values to prevent adverse outcomes (Karch, 2022).

Adverse Effects of ACE Inhibitors

When prescribing ACE inhibitors, it is essential to monitor for common adverse reactions.

Question: Which adverse effects should the nurse consider?

Possible Effects	Relevant Consideration
Diarrhea	Less common but possible GI reaction
Fatigue	Frequently reported and may affect adherence
Restlessness	Not typical, usually unrelated
Headaches	Occasional side effect
Dry cough	Very common due to bradykinin buildup
Tremors	Not typically associated

Answer: The most significant adverse effect is a persistent dry cough, which often leads to discontinuation. Fatigue and headaches are also possible. Tremors and restlessness are not typically linked to ACE inhibitors (Rosenthal & Burchum, 2021).

Hypertensive Emergency Treatment

Question: Which drug should the nurse expect for a patient in hypertensive crisis?

Answer: The drug of choice is sodium nitroprusside (Nitropress), a potent vasodilator that provides rapid blood pressure control. Other medications like losartan, captopril, or prazosin are not appropriate for immediate crisis management because their onset of action is slower (Karch, 2022).

Adverse Effects of Beta1 Blockers in Heart Failure and Hypertension

Question: Which adverse effects should the nurse monitor?

Adverse Effect	Clinical Significance
Edema	Suggests worsening heart failure
Nightmares	Possible CNS effect but less concerning
Shortness of breath	Can indicate bronchospasm or worsening cardiac status
Nervousness	Rare, usually mild
Constipation	Minor, not life-threatening

Answer: The most serious effects to monitor are edema and shortness of breath, as these may indicate worsening cardiac function or respiratory compromise (Rosenthal & Burchum, 2021).

Patient Education on Alpha Blockers for Hypertension

Question: What should patients be taught when starting alpha blockers?

Answer: Patients should be advised to change positions slowly (orthostatic precautions) to prevent dizziness, lightheadedness, or fainting. This is particularly important during the first dose, known as the “first-dose phenomenon” (Karch, 2022).

ACE Inhibitor Selection Based on Patient Characteristics

Irene (liver dysfunction & hypertension): Captopril is most appropriate because it is not a prodrug and does not rely on hepatic metabolism.
Kory (poor adherence): Lisinopril or benazepril, which are long-acting ACE inhibitors, are suitable since they require less frequent dosing and improve adherence (Rosenthal & Burchum, 2021).

Antihypertensives for African-American Patients

Research indicates that calcium channel blockers (CCBs) and thiazide diuretics are generally more effective in African-American patients compared to ACE inhibitors or beta blockers. This improved efficacy is related to different pathophysiological mechanisms of hypertension across racial groups (Flack et al., 2010).

Purpose of Antianginal Drug Therapy

Question: What is the main goal of antianginal therapy?

Answer: The primary objective is to increase oxygen delivery to ischemic cardiac tissue and reduce myocardial oxygen demand. This helps alleviate angina symptoms and prevents ischemic complications (Karch, 2022).

Treatment for Coronary Artery Spasms

Question: Which drug is most effective for coronary artery spasms?

Answer: Calcium channel blockers are the drugs of choice because they relax vascular smooth muscle and directly relieve vasospasm (Rosenthal & Burchum, 2021).

Nitroglycerin and Chest Pain

Question: What should a patient do if chest pain worsens after one sublingual nitroglycerin?

Answer: The immediate action is to call 911. Persistent chest pain may signal myocardial infarction, requiring emergency intervention (Karch, 2022).

ACE Inhibitor Effects in Heart Failure

Question: What should be monitored when starting ACE inhibitors in heart failure?

Answer: Nurses must monitor for hyperkalemia, as ACE inhibitors reduce aldosterone levels, leading to potassium retention (Rosenthal & Burchum, 2021).

Digoxin and Low Radial Pulse

Question: What should the nurse do before giving digoxin when the radial pulse is 52 bpm?

Answer: The nurse should assess the apical pulse for one full minute before deciding whether to administer or hold the medication. A low pulse may indicate digoxin toxicity (Karch, 2022).

Digoxin and Potassium Levels

Low potassium levels (hypokalemia) significantly increase the risk of digoxin toxicity, which can lead to dangerous arrhythmias. Electrolytes should be closely monitored in patients receiving digoxin (Rosenthal & Burchum, 2021).

Digoxin Therapy and Therapeutic Response

Therapeutic responses include:

Improved urinary output (indicating improved cardiac function).
Reduced dyspnea and improved exercise tolerance.

Patient teaching: Avoid excessive dietary bran intake since it reduces digoxin absorption, decreasing drug effectiveness (Karch, 2022).

Sudden Cardiac Death Prevention After Myocardial Infarction

After myocardial infarction, patients are often prescribed a Class II antidysrhythmic (beta-blocker) to reduce mortality and prevent sudden cardiac death. In patients with asthma, a cardioselective beta-blocker is preferred to minimize bronchospasm risk (Rosenthal & Burchum, 2021).

References

Flack, J. M., Sica, D. A., Bakris, G., & Ferdinand, K. C. (2010). Management of high blood pressure in Blacks: An update of the International Society on Hypertension in Blacks consensus statement. Hypertension, 56(5), 780–800. https://doi.org/10.1161/HYPERTENSIONAHA.110.152892
Karch, A. M. (2022). Focus on nursing pharmacology (9th ed.). Wolters Kluwer.

NR 293 Quiz 3

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacology for nursing care (11th ed.). Elsevier.