Pharmacology Applications Midterm Exam
Directions: The midterm exam consists of three case study scenarios, medication antidote, 2 drug calculation questions and two multiple choice questions. Read each case study thoroughly prior to answering the question. Your response should be thorough, complete and should demonstrate critical thinking and synthesis of all information presented in the case study. GOOD LUCK!
Case Study #1 Angina Pectoris
(20 points)
A 74 year old man with a history of stable angina, asthma and hypertension is admitted to the hospital with substernal chest pain that was not relieved by three sublingual nitroglycerin tablets. In the emergency department the patient is prescribed diltiazem and IV Nitroglycerin.
What actions must the nurse taken when administering IV Nitroglycerin?
The patient’s pain is relieved after receiving a dosage of 330mcg/min. He is admitted to the coronary care unit. His vital signs are stable, and he is currently without pain. Cardiac enzymes levels do not suggest myocardial cell death. The ECG shows normal sinus rhythm. The physicians believe that the patient is having classic angina and not a myocardial infarction. The attending physician orders that the patient be weaned from the nitroglycerin drip and that nitroglycerin transdermal patches 10mg/24 hour to be started. He is also prescribed aspirin 81mg, diltiazem CD (30mg) and Ramipril (Alatace) 2.5 mg, which he is to receive once a day.
If the prescriber wants a continuous administration of nitroglycerin when changing the patient from the nitroglycerin drip to the patch, when, in relation to discontinuing the IV nitroglycerin, should the nurse apply the nitroglycerin patch?
What teaching should the nurse provide about administration of the nitroglycerin patch?
The nurse asks the patient’s spouse to bring the patient’s supply of sublingual nitroglycerin tablets to the hospital. The patient’s spouse shows the nurse a small plastic pill container “Heart pills” is handwritten on a masking tape label. What teaching should the nurse provide?
The nurse is reconciling medications during discharge instructions. The patient admits to adherence issues with taking his antihypertensive drug therapy because of experiencing erectile dysfunction. He asks the nurse about using sildenafil (Viagra). What information should the nurse provide?
Dosage Calculation:
(5 points)
Nitroglycerin ointment 2% is dispensed from a tube, and the length of the ribbon squeezed from the tube determines the dosage. One inch contains 15mg of nitroglycerin. How many inches would equal 30 mg? Answer: ____________
Case Study#2 Diuretics
(15 points)
An 80 year old non -smoking woman has been taking spironolactone (Aldactone) 100mg/day for about 6 years to control her moderate hypertension and mild heart failure. She comes to the emergency department with bilateral crackles in the lower and middle lobes and a blood pressure of 190/120mm Hg. She is short of breath, very anxious, tachycardia (HR134 beats/min) and diaphoretic. Her family assures you that she taking her medication. The family tells you she has been getting worse over the past 2 weeks since having friends bring her favorite lunch of hot dogs and potato chips every day. Pulmonary edema is diagnosed. Orders include STAT intravenous push furosemide (Lasix) 40mg, morphine sulfate 2mg, 3 L of Oxygen via nasal cannula, electrolytes, complete blood count and an indwelling Foley catheter.
How will furosemide (Lasix) help relieve this patient’s symptoms?
The patient will need to be started on digoxin. What must the nurse remember now that the patient is on digoxin and furosemide (Lasix)? What laboratory values need to be monitored?
What information should the nurse provide to prevent problems with drug interactions?
Dosage Calculation:
(5 points)
Furosemide (Lasix) 40 mg orally is prescribed. Available is furosemide (Lasix) 80mg tablets. How many tablets will the nurse administer?
Answer: ___________
Case Study# 3 Diabetes Mellitus
(25 points)
The nurse educator is presenting a seminar on insulin to nursing students. What would be the best response to these questions?
Why are regular and rapid acting insulins the only insulins administered intravenously?
How is using Detemir (Levemir) or glargine (Lantus) insulin better than NPH insulin?
What should the patient or nurse do if a vial of insulin aspart is cloudy?
Multiple Choice: Complete the two multiple choice questions below.
A patient has been prescribed 5 units of insulin aspart (NovoLog) and 25 units of insulin Detemir (Levemir) to be administered at 0800. What should the nurse do?
Draw up the two insulins in different syringes
Draw up 5 units of aspart insulin first, then 25 units of detemir insulin in the same syringe.
Draw up the clear insulin, then the cloudy insulin, in the same syringe.
Draw up 25 units of detemir insulin first, then 5 units aspart insulin in the same syringe.
Answer: ____________________
What special administration techniques must the nurse use when administering NPH insulin?
Never Mix with another insulin
Administer the insulin only at bedtime
Roll the vial gently to mix particles in solution
When mixing with another insulin, draw the NPH into the syringe first
Answer: ____________________
(30 Points) Medication Antidote
What medication do you pull to reverse the effects of?
Drugs/ Classification
Antidote:
Digoxin
Heroin
Coumadin
Acetaminophen
Benzodiazepines
Heparin
Narcotics
Potassium
Anticholinergics
Tricyclic Antidepressant
Use the following choices to complete the specific antidote reversal agent:
Acetylcysteine Mucomyst
Romazicon ( Flumazenil)
Digiband
Narcan ( Naloxone)
Protamine Sulfate
Physostigmine
Phytonadiaone Vitamin K
Insulin, Bicarb, Kayexalate
Physostigmine, Bicarb
5