Deck 21: Drug Therapy in Acute Care

Question 1

A patient arrives in the emergency department reporting chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug will the provider order to be given immediately?

A) Aspirin 325 mg chewable
B) ( $\beta$ ) blocker given IV
C) Ibuprofen 400 mg orally
D) Morphine intravenously

Answer 1

Aspirin 325 mg chewable

Question 2

A patient is considering getting epidural anesthesia during the delivery of her child. What consideration should the provider discuss with her to best assure the patient's informed consent?

A) Opioid analgesics can induce strong tolerance and withdrawal effects.
B) She will be unconscious during the delivery due to anesthesia.
C) Anesthetic drugs may enter systemic circulation and therefore reach the neonate.
D) Anesthetic drugs are metabolized very quickly and may lose effectiveness during delivery.

Answer 2

Anesthetic drugs may enter systemic circulation and therefore reach the neonate.

Question 3

A patient arrives in the emergency department reporting muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats/minute, a respiratory rate of 18 breaths/minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The provider will be most concerned about the patient's use of what medication?

A) Antacids
B) Aspirin
C) Laxatives
D) Potassium supplements

Answer 3

Antacids

Question 4

A provider is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during history taking, would contraindicate this type of therapy?

A) The patient just completed her last menstrual cycle.
B) The patient states that the chest pain started 1 hour ago.
C) The patient has a history of a small cerebral aneurysm.
D) The patient has hypertension that is well controlled by diuretic therapy.

Question 5

A patient who has undergone a primary percutaneous coronary intervention (PCI) with a stent placement is prescribed a daily dose of 81 mg of aspirin and clopidogrel. The patient asks how long the medications must be taken. What will the prescriber tell this patient about the medication regimen?

A) This drug regimen will continue indefinitely.
B) The clopidogrel will be discontinued in 1 year and the aspirin will be given indefinitely.
C) The aspirin will be discontinued in 1 year and the clopidogrel will be given indefinitely.
D) Both drugs will be discontinued in 1 year.

Question 6

A patient is brought to the emergency department with a respiratory rate of 32 breaths/minute and a heart rate of 90 beats/minute. While the injuries are minor, the patient is inconsolable and hysterical. The provider will order what initial management intervention?

A) Administration of a gas mixture of 5% carbon dioxide (CO₂)
B) Providing 100% oxygen via nasal cannula
C) Giving sodium bicarbonate IV
D) Providing sedatives to calm the patient

Question 7

What is the most important question a provider should ask a patient before prescribing abciximab?

A) "Do you take any drugs that affect blood clotting?"
B) "Are you allergic to any anticoagulants?"
C) "How long have you been hypertensive?"
D) "Are you diabetic?"

Question 8

A patient with a history of congestive heart failure is admitted to the hospital. The admission assessment and interview provides the following information: $\bullet$ The patient is taking a thiazide diuretic and digoxin
$\bullet$ Admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L.
When the provider is notified of this information what action will be the priority?

A) Administration of the digoxin and maintaining close cardiac monitoring
B) Putting a hold on the digoxin and determining measures to normalize the laboratory values
C) Putting a hold on the thiazide diuretic and increasing the digoxin dosage
D) Ordering an electrocardiogram (ECG) and reordering the labs

Question 9

A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a $\beta$ blocker, and an ACE inhibitor daily, and uses nitroglycerin as needed for angina. The patient's BMI is 24.5 kg/m² and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What action will the provider take to provide effective care for the patient?

A) Prescribe an antihypertensive medication.
B) Order counseling about a weight loss diet.
C) Discontinue the ACE inhibitor.
D) Order high-dose statin therapy.

Question 10

A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic dehydration has occurred. Which solution will be ordered to treat this patient?

A) 0.45% sodium chloride in sterile water
B) 0.9% sodium chloride in sterile water
C) 3% sodium chloride in sterile water
D) 5% dextrose solution

Question 11

A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will the provider prescribe to augment this procedure?

A) ( $\beta$ ) blocker and nitroglycerin
B) Abciximab and a fibrinolytic drug
C) Angiotensin-converting enzyme (ACE) inhibitor and aspirin
D) Heparin, aspirin, and clopidogrel

Question 12

A patient who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The patient has a creatinine clearance of 28 mL/minute. In addition to the fibrinolytic agent, which medication will the provider prescribe for this patient?

A) Aspirin
B) Bivalirudin
C) Clopidogrel
D) Fondaparinux

Question 13

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide, digoxin, and spironolactone. A diet history reveals the use of salt substitutes. The patient appears confused and dyspneic and reports tingling of hands and feet. Which action will the provider take to provide effective patient care?

A) Prescribe both an electrocardiogram and serum electrolyte levels.
B) Order strict monitoring of urine output and prescribe intravenous potassium.
C) Hold the next dose of furosemide and prescribe intravenous magnesium sulfate.
D) Order intravenous insulin to help regulate extracellular potassium.

Question 14

A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The provider will prescribe which therapy?

A) Intravenous hypertonic fluids given slowly over several hours
B) Intravenous hypotonic fluids administered in stages
C) Intravenous isotonic fluids given as a rapid bolus
D) Oral electrolyte replacement fluids with potassium

Question 15

The provider and a patient with a history of myocardial infarction should discuss the need to take which medications indefinitely? (Select all that apply.)

A) ACE inhibitors
B) Alteplase
C) Aspirin
D) ( $\beta$ ) blockers
E) Clopidogrel