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?

Accepted Answer

Aspirin is given immediately to patients with suspected myocardial infarction to inhibit platelet aggregation and reduce the risk of further clot formation.

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?

Accepted Answer

Epidural anesthesia involves administering anesthetic drugs near the spinal cord to block pain in a specific region of the body, such as during childbirth. While the patient remains conscious and alert, there is a possibility that the drugs used can enter the systemic circulation and potentially affect the neonate. This is a critical consideration for informed consent, as it directly relates to the safety and well-being of both the mother and the child. Options A, B, and D do not accurately describe the effects or considerations specific to epidural anesthesia during delivery.

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?

Accepted Answer

A

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?

Accepted Answer

Thrombolytic therapy is contraindicated in patients with a history of cerebral aneurysm due to the increased risk of bleeding, including potentially fatal intracranial hemorrhage.

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?

Accepted Answer

After a primary percutaneous coronary intervention (PCI) with stent placement, it is standard practice to prescribe dual antiplatelet therapy, typically consisting of aspirin and a P2Y12 inhibitor like clopidogrel. Aspirin is usually continued indefinitely for its antiplatelet effects to prevent clot formation, while clopidogrel is often recommended for a duration of up to 12 months post-PCI to reduce the risk of stent thrombosis and other cardiovascular events. This regimen helps balance the benefits of preventing clot-related complications with the risk of bleeding.

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?

Accepted Answer

Administering a gas mixture of 5% carbon dioxide can help manage hyperventilation syndrome by increasing CO2 levels, reducing respiratory alkalosis, and calming the patient.

Question 7

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

Accepted Answer

Abciximab is a medication that affects blood clotting by inhibiting platelet aggregation, which is crucial in the clotting process. Asking about other drugs that affect blood clotting is important to avoid excessive bleeding risks.

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?

Accepted Answer

The patient's potassium level is low (3 mEq/L), which can increase the risk of digoxin toxicity. Therefore, the priority is to hold the digoxin and address the abnormal laboratory values, particularly the hypokalemia, before continuing with digoxin administration.

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?

Accepted Answer

The patient's serum LDL is 150 mg/dL, which is above the recommended level for someone with a history of STEMI. High-dose statin therapy is indicated to lower LDL cholesterol and reduce the risk of future cardiovascular events.

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?

Accepted Answer

Isotonic dehydration occurs when the body loses water and electrolytes (salts) in equal proportions. To treat isotonic dehydration, a solution that closely matches the body's natural fluid composition is needed. 0.9% sodium chloride in sterile water (normal saline) is an isotonic solution, making it the appropriate choice for rehydration in this scenario.

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?

Accepted Answer

Heparin, aspirin, and clopidogrel are commonly used together in the setting of a primary percutaneous coronary intervention (PCI) for a patient with STEMI to prevent clot formation and improve outcomes.

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?

Accepted Answer

Bivalirudin is a direct thrombin inhibitor that does not cause HIT and is used in patients with a history of HIT. It is preferred in this scenario because it provides anticoagulation without the risk associated with heparin products.

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?

Accepted Answer

The symptoms and medication history suggest possible electrolyte imbalances, particularly concerning potassium levels due to the use of furosemide (a potassium-wasting diuretic), spironolactone (a potassium-sparing diuretic), and digoxin, which has a narrow therapeutic window affected by potassium levels. The use of salt substitutes (often high in potassium) further complicates the picture. An electrocardiogram can help assess the cardiac impact of electrolyte imbalances, and serum electrolyte levels will provide specific information about the imbalance, guiding appropriate treatment.

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?

Accepted Answer

The answer of A patient collapses after running a marathon...

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.)

Accepted Answer

The answer of The provider and a patient with a...

Quiz 21: Drug Therapy in Acute Care