Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
Chapter 1: Introduction to Pharmacology and the Nursing
Process
Topic: Foundations of Pharmacology and Nursing Process
Integration
Subtopics:
, • Drug nomenclature and classifications
• Pharmacokinetics principles
• Pharmacodynamics principles
• Nursing process in medication administration
• Medication safety principles
• Patient-centered care
• Lifespan considerations
Difficulty: Mixed
Question Distribution:
• MCQ: 8
• SATA: 5
• NGN Case Study: 3
• Bow-Tie: 2
• Matrix/Grid: 1
• Medication Calculation: 1
QUESTION 1
Item Type: MCQ
,Clinical Scenario:
A 67-year-old female patient with a history of hypertension,
type 2 diabetes mellitus, and chronic kidney disease (Stage 3) is
admitted to the medical-surgical unit with community-acquired
pneumonia. The healthcare provider prescribes intravenous
ceftriaxone 1 gram daily. The patient's medication reconciliation
reveals she takes lisinopril 20 mg daily, metformin 1000 mg
twice daily, and furosemide 40 mg daily. The nurse reviews the
patient's laboratory results: serum creatinine 1.8 mg/dL, BUN
42 mg/dL, eGFR 35 mL/min/1.73m², and serum potassium 4.9
mEq/L.
Question Stem:
The nurse should prioritize which nursing action before
administering the first dose of ceftriaxone?
Answer Options:
A. Administer the medication as prescribed and monitor for
allergic reaction
B. Hold the medication and notify the healthcare provider
about the renal function results
C. Administer the medication with 500 mL of normal saline to
protect renal function
D. Request an order for diphenhydramine to prevent potential
hypersensitivity reaction
, Correct Answer: B. Hold the medication and notify the
healthcare provider about the renal function results
Comprehensive Rationale:
Ceftriaxone is a third-generation cephalosporin antibiotic that
exhibits significant protein binding (85-95%) and is primarily
eliminated through both renal and biliary routes. In patients
with renal impairment, particularly those with an eGFR below
40 mL/min/1.73m², dosage adjustment is required to prevent
drug accumulation and potential toxicity. The patient's eGFR of
35 mL/min/1.73m² indicates Stage 3 chronic kidney disease,
which significantly impacts drug clearance.
Pharmacokinetically, ceftriaxone's half-life increases from
approximately 6-9 hours in patients with normal renal function
to 12-16 hours in those with severe renal impairment. However,
because ceftriaxone undergoes both renal and hepatic
elimination, dosage adjustment guidelines recommend
maintaining the standard dose but extending the dosing interval
to every 12-24 hours based on the degree of renal impairment.
In this patient, the eGFR of 35 mL/min/1.73m² would typically
warrant a dosage adjustment or increased monitoring for
adverse effects.
The nurse's action of holding the medication and notifying the
healthcare provider demonstrates appropriate clinical judgment
and medication safety practices. The nursing process at this
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
Chapter 1: Introduction to Pharmacology and the Nursing
Process
Topic: Foundations of Pharmacology and Nursing Process
Integration
Subtopics:
, • Drug nomenclature and classifications
• Pharmacokinetics principles
• Pharmacodynamics principles
• Nursing process in medication administration
• Medication safety principles
• Patient-centered care
• Lifespan considerations
Difficulty: Mixed
Question Distribution:
• MCQ: 8
• SATA: 5
• NGN Case Study: 3
• Bow-Tie: 2
• Matrix/Grid: 1
• Medication Calculation: 1
QUESTION 1
Item Type: MCQ
,Clinical Scenario:
A 67-year-old female patient with a history of hypertension,
type 2 diabetes mellitus, and chronic kidney disease (Stage 3) is
admitted to the medical-surgical unit with community-acquired
pneumonia. The healthcare provider prescribes intravenous
ceftriaxone 1 gram daily. The patient's medication reconciliation
reveals she takes lisinopril 20 mg daily, metformin 1000 mg
twice daily, and furosemide 40 mg daily. The nurse reviews the
patient's laboratory results: serum creatinine 1.8 mg/dL, BUN
42 mg/dL, eGFR 35 mL/min/1.73m², and serum potassium 4.9
mEq/L.
Question Stem:
The nurse should prioritize which nursing action before
administering the first dose of ceftriaxone?
Answer Options:
A. Administer the medication as prescribed and monitor for
allergic reaction
B. Hold the medication and notify the healthcare provider
about the renal function results
C. Administer the medication with 500 mL of normal saline to
protect renal function
D. Request an order for diphenhydramine to prevent potential
hypersensitivity reaction
, Correct Answer: B. Hold the medication and notify the
healthcare provider about the renal function results
Comprehensive Rationale:
Ceftriaxone is a third-generation cephalosporin antibiotic that
exhibits significant protein binding (85-95%) and is primarily
eliminated through both renal and biliary routes. In patients
with renal impairment, particularly those with an eGFR below
40 mL/min/1.73m², dosage adjustment is required to prevent
drug accumulation and potential toxicity. The patient's eGFR of
35 mL/min/1.73m² indicates Stage 3 chronic kidney disease,
which significantly impacts drug clearance.
Pharmacokinetically, ceftriaxone's half-life increases from
approximately 6-9 hours in patients with normal renal function
to 12-16 hours in those with severe renal impairment. However,
because ceftriaxone undergoes both renal and hepatic
elimination, dosage adjustment guidelines recommend
maintaining the standard dose but extending the dosing interval
to every 12-24 hours based on the degree of renal impairment.
In this patient, the eGFR of 35 mL/min/1.73m² would typically
warrant a dosage adjustment or increased monitoring for
adverse effects.
The nurse's action of holding the medication and notifying the
healthcare provider demonstrates appropriate clinical judgment
and medication safety practices. The nursing process at this
