NUR 02 PHARMACOLOGY EXAM 1
,1-A client with primary hypothyroidism has been taking levothyroxine for 1 year. Laboratory results
today show high levels of thyroid stimulating hormone (TSH). Which teaching should the nurse plan
to implement?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3 months."
3. "Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness."
4. "You will need to get this new prescription filled for an increased dose of
levothyroxine."
Explanation:
Levothyroxine (Synthroid) is a thyroid hormone
replacement drug that is the most common treatment
for hypothyroidism, a condition in which thyroid
hormone deficit slows the metabolic rate. In primary
hypothyroidism, the deficit occurs due to a problem in
thyroid gland tissue or hormone synthesis. TSH is
released from the pituitary and stimulates the thyroid
gland to secrete thyroid hormones (T 3, T4). In primary
hypothyroidism, when the thyroid does not synthesize
enough T3 or T4, the pituitary releases additional TSH to
compensate. This results in high levels of circulating
TSH. Clients are prescribed levothyroxine (or their
dose is augmented) to increase T 3 and T4; this lowers
TSH and leads to a euthyroid (normal) state (Options 1
and 2).
(Option 3) For best results, levothyroxine should be
taken on a consistent morning schedule before food
ingestion. Foods containing certain ingredients (eg,
cottonseed meal, walnuts, soybean flower, dietary fiber,
calcium) can affect drug absorption.
Educational objective:
In primary hypothyroidism, the deficit occurs due to a
problem in thyroid gland tissue or hormone synthesis.
When the thyroid does not synthesize enough T3 or T4,
the pituitary releases additional TSH to compensate.
This results in high levels of circulating TSH.
Levothyroxine is usually started/increased to lead to a
euthyroid (normal) state.
2-A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5
days. The nurse reviews the coagulation studies and the medication administration record. Which
prescription would the nurse question? Click on the exhibit button for additional information.
, 1. Epoetin
2. Sodium polystyrene sulfonate
3. Vitamin K
4. Warfarin
Explanation:
Vitamin K (phytonadione) is a fat-soluble
vitamin that is administered as an antidote
for warfarin-related bleeding. This
medication prescription should be
questioned as vitamin K reverses the
anticoagulant effect of warfarin, and the
client's coagulation studies are in the
therapeutic range (aPTT 46-70 sec, INR 2-
3).
(Option 1) Epoetin (Procrit) is a synthetic
hormone that stimulates the production of
erythropoietin and is used to treat anemia associated with chronic kidney disease. This is an
appropriate prescription.
(Option 2) Sodium polystyrene sulfonate (Kayexalate) is a sodium exchange resin administered to
reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia.
This is an appropriate prescription for this client.
(Option 4) Warfarin (Coumadin) is a vitamin K antagonist used for long-term anticoagulation that is
started about 5 days before a continuous heparin infusion is discontinued. An overlap of the
parenteral and oral anticoagulant is required for about 5 days as this is the time it takes warfarin to
reach therapeutic level. This is an appropriate prescription for this client.
Educational objective:
Anticoagulants stop thrombus formation by interfering with the coagulation cascade. Parenteral
heparin and oral warfarin affect the clotting cascade differently; therefore, a 5-day overlap for the 2
drugs is required. This allows warfarin to reach a therapeutic level before the continuous heparin
infusion is stopped.
3-A home health nurse visits a client 2 weeks after discharge from the hospital. The client
experienced an acute myocardial infarction and subsequent heart failure. Home medications are
listed in the exhibit. Which symptom reported by the client is most concerning to the nurse? Click
on the exhibit button for additional information.
1. Bruising easily, especially on arms
2. Fatigue
3. Feeling depressed
4. Muscle cramps in legs
, Explanation:
The nurse would be most concerned with the client's report of muscle cramps in the legs. This could
be a sign of hypokalemia caused by use of the diuretic furosemide or possibly a reaction from the
statin medication atorvastatin.
Hypokalemia may manifest as muscle cramps, weakness, or paralysis and typically starts with the
leg muscles. Hypokalemia could be dangerous in this client due to possible arrhythmias in the
presence of existing cardiac dysfunction. The client may need to be started on supplemental
potassium and a high-potassium diet if the serum potassium level is low. If the potassium level is
normal, atorvastatin may be responsible for muscle cramps.
(Option 1) Bruising, especially on the upper extremities, is common with the use of antiplatelet
agents such as aspirin and clopidogrel. The nurse should teach the client to monitor for other, more
severe signs of bleeding, such as blood in the stool.
(Option 2) The myocardial infarction and heart failure have most likely reduced the client's functional
capacity and can cause fatigue. Beta blockers such as metoprolol can also cause fatigue. This will
improve with time, and the nurse should talk to the client about possible cardiac rehabilitation.
(Option 3) Feeling depressed is common after an acute health-related event such as a myocardial
infarction. The client needs to be evaluated further and may need an antidepressant. However,
feelings of depression are not immediately life-threatening unless the client exhibits suicidal ideation.
Educational objective:
The nurse should recognize muscle cramps in the legs as a possible sign of hypokalemia in the client
taking diuretics. Muscle cramps should be reported to the health care provider in anticipation of
checking a potassium level, adding a potassium supplement, and instructing the client to eat
potassium-rich foods.
4- The health care provider (HCP) has told a client to take over-the-counter (OTC) supplemental
calcium carbonate 1000 mg/day for treatment of osteoporosis. Which instruction should the clinic
nurse give the client?
1. Monthly calcium levels will need to be drawn
2. Stop vitamin D supplements when taking calcium
3. Take calcium at bedtime
4. Take calcium in divided doses with food
Explanation:
,1-A client with primary hypothyroidism has been taking levothyroxine for 1 year. Laboratory results
today show high levels of thyroid stimulating hormone (TSH). Which teaching should the nurse plan
to implement?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3 months."
3. "Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness."
4. "You will need to get this new prescription filled for an increased dose of
levothyroxine."
Explanation:
Levothyroxine (Synthroid) is a thyroid hormone
replacement drug that is the most common treatment
for hypothyroidism, a condition in which thyroid
hormone deficit slows the metabolic rate. In primary
hypothyroidism, the deficit occurs due to a problem in
thyroid gland tissue or hormone synthesis. TSH is
released from the pituitary and stimulates the thyroid
gland to secrete thyroid hormones (T 3, T4). In primary
hypothyroidism, when the thyroid does not synthesize
enough T3 or T4, the pituitary releases additional TSH to
compensate. This results in high levels of circulating
TSH. Clients are prescribed levothyroxine (or their
dose is augmented) to increase T 3 and T4; this lowers
TSH and leads to a euthyroid (normal) state (Options 1
and 2).
(Option 3) For best results, levothyroxine should be
taken on a consistent morning schedule before food
ingestion. Foods containing certain ingredients (eg,
cottonseed meal, walnuts, soybean flower, dietary fiber,
calcium) can affect drug absorption.
Educational objective:
In primary hypothyroidism, the deficit occurs due to a
problem in thyroid gland tissue or hormone synthesis.
When the thyroid does not synthesize enough T3 or T4,
the pituitary releases additional TSH to compensate.
This results in high levels of circulating TSH.
Levothyroxine is usually started/increased to lead to a
euthyroid (normal) state.
2-A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5
days. The nurse reviews the coagulation studies and the medication administration record. Which
prescription would the nurse question? Click on the exhibit button for additional information.
, 1. Epoetin
2. Sodium polystyrene sulfonate
3. Vitamin K
4. Warfarin
Explanation:
Vitamin K (phytonadione) is a fat-soluble
vitamin that is administered as an antidote
for warfarin-related bleeding. This
medication prescription should be
questioned as vitamin K reverses the
anticoagulant effect of warfarin, and the
client's coagulation studies are in the
therapeutic range (aPTT 46-70 sec, INR 2-
3).
(Option 1) Epoetin (Procrit) is a synthetic
hormone that stimulates the production of
erythropoietin and is used to treat anemia associated with chronic kidney disease. This is an
appropriate prescription.
(Option 2) Sodium polystyrene sulfonate (Kayexalate) is a sodium exchange resin administered to
reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia.
This is an appropriate prescription for this client.
(Option 4) Warfarin (Coumadin) is a vitamin K antagonist used for long-term anticoagulation that is
started about 5 days before a continuous heparin infusion is discontinued. An overlap of the
parenteral and oral anticoagulant is required for about 5 days as this is the time it takes warfarin to
reach therapeutic level. This is an appropriate prescription for this client.
Educational objective:
Anticoagulants stop thrombus formation by interfering with the coagulation cascade. Parenteral
heparin and oral warfarin affect the clotting cascade differently; therefore, a 5-day overlap for the 2
drugs is required. This allows warfarin to reach a therapeutic level before the continuous heparin
infusion is stopped.
3-A home health nurse visits a client 2 weeks after discharge from the hospital. The client
experienced an acute myocardial infarction and subsequent heart failure. Home medications are
listed in the exhibit. Which symptom reported by the client is most concerning to the nurse? Click
on the exhibit button for additional information.
1. Bruising easily, especially on arms
2. Fatigue
3. Feeling depressed
4. Muscle cramps in legs
, Explanation:
The nurse would be most concerned with the client's report of muscle cramps in the legs. This could
be a sign of hypokalemia caused by use of the diuretic furosemide or possibly a reaction from the
statin medication atorvastatin.
Hypokalemia may manifest as muscle cramps, weakness, or paralysis and typically starts with the
leg muscles. Hypokalemia could be dangerous in this client due to possible arrhythmias in the
presence of existing cardiac dysfunction. The client may need to be started on supplemental
potassium and a high-potassium diet if the serum potassium level is low. If the potassium level is
normal, atorvastatin may be responsible for muscle cramps.
(Option 1) Bruising, especially on the upper extremities, is common with the use of antiplatelet
agents such as aspirin and clopidogrel. The nurse should teach the client to monitor for other, more
severe signs of bleeding, such as blood in the stool.
(Option 2) The myocardial infarction and heart failure have most likely reduced the client's functional
capacity and can cause fatigue. Beta blockers such as metoprolol can also cause fatigue. This will
improve with time, and the nurse should talk to the client about possible cardiac rehabilitation.
(Option 3) Feeling depressed is common after an acute health-related event such as a myocardial
infarction. The client needs to be evaluated further and may need an antidepressant. However,
feelings of depression are not immediately life-threatening unless the client exhibits suicidal ideation.
Educational objective:
The nurse should recognize muscle cramps in the legs as a possible sign of hypokalemia in the client
taking diuretics. Muscle cramps should be reported to the health care provider in anticipation of
checking a potassium level, adding a potassium supplement, and instructing the client to eat
potassium-rich foods.
4- The health care provider (HCP) has told a client to take over-the-counter (OTC) supplemental
calcium carbonate 1000 mg/day for treatment of osteoporosis. Which instruction should the clinic
nurse give the client?
1. Monthly calcium levels will need to be drawn
2. Stop vitamin D supplements when taking calcium
3. Take calcium at bedtime
4. Take calcium in divided doses with food
Explanation:
