ATI RN Custom Pharmacology Exam 1
Questions and Correct Answers 2024
Phenytoin has a narrow therapeutic index. The nurse recognizes that this
characteristic indicates which of these?
A. The safe and the toxic plasma levels of the drug are very close to each other.
B. The phenytoin has a low chance of being effective.
C. There is no difference between safe and toxic plasma levels.
D. A very small dosage can result in the desired therapeutic effect.
RATIONALES
Choice A rationale:
Phenytoin is an anticonvulsant drug used in the prophylaxis and control of various types of
seizures. It has a narrow therapeutic index, which means that the safe and toxic plasma levels of
the drug are very close to each other. This characteristic makes the dosing of phenytoin
challenging, as even small deviations from the recommended therapeutic range can lead to
suboptimal treatment or adverse effects. Therapeutic effect without clinical signs of toxicity
occurs more often with serum total concentrations between 10 and 20 mcg/mL34. Therefore,
clinicians are advised to initiate therapeutic drug monitoring in patients who require phenytoin.
Choice B rationale:
The statement that phenytoin has a low chance of being effective is incorrect. Phenytoin is a
widely used and effective anticonvulsant. It works by slowing down impulses in the brain that
cause seizures. It is used to control seizures but does not treat all types of seizures. The
effectiveness of phenytoin is not determined by its narrow therapeutic index but by its
pharmacological action in the brain.
Choice C rationale:
The assertion that there is no difference between safe and toxic plasma levels of phenytoin is
incorrect. There is indeed a difference between the safe (therapeutic) and toxic levels of
phenytoin. The therapeutic range for phenytoin is typically between 10 and 20 mcg/mL34.
Levels above this range can lead to toxicity, while levels below this range may not provide the
desired therapeutic effect.
Choice D rationale:
The statement that a very small dosage of phenytoin can result in the desired therapeutic effect
is not entirely accurate. While it‟s true that phenytoin is effective in controlling seizures, the
dosage required to achieve this effect is not necessarily “very small”. The usual adult dose for
seizures is 100 mg orally 3 times a day. The dosage may need to be adjusted based on individual
patient factors and response to therapy. Therefore, it‟s not accurate to generalize that a “very
small” dosage will result in the desired therapeutic effect for all patients.
,During antibiotic therapy, the nurse will monitor closely for signs and symptoms
of a hypersensitivity reaction. Which of these assessment findings may be an
indication of a hypersensitivity reaction? (Select all that apply.)
A. Shortness of breath
B. Black hairy tongue
C. Itching
D. Swelling of the tongue
RATIONALES
Choice A rationale:
Shortness of breath is a common symptom of a hypersensitivity reaction. This occurs because
the body‟s immune system responds to a foreign substance, known as an antigen, by producing
specific antibodies. This immune response can cause inflammation and swelling in various parts
of the body, including the airways, leading to shortness of breath.
Choice B rationale:
A black hairy tongue is not typically associated with a hypersensitivity reaction. It is a condition
that causes the tongue to appear black and hairy, and it‟s usually caused by an overgrowth of
bacteria or yeast on the tongue. It‟s not related to allergies or hypersensitivity reactions.
Choice C rationale:
Itching is another common symptom of a hypersensitivity reaction. When the body encounters
an antigen, it triggers an immune response that releases chemicals like histamine. Histamine
can cause itching, among other symptoms.
Choice D rationale:
Swelling of the tongue can be a symptom of a severe hypersensitivity reaction known as
anaphylaxis. This is a medical emergency that requires immediate attention. The swelling is
caused by inflammation in response to an antigen.
Choice E rationale:
Wheezing is a symptom of a hypersensitivity reaction, specifically type I hypersensitivity. This
type of reaction includes allergic disorders, which affect the lungs among other parts of the
body. The immune response to an antigen can cause the airways to narrow and produce a
wheezing sound.
A patient has a urinary tract infection. The nurse knows that which class of drugs
is especially useful for such infections?
A. Macrolides
B. Sulfonamides
C. Carbapenems
D. Tetracyclines
RATIONALES
Choice A rationale:
,Macrolides Macrolides, such as erythromycin and azithromycin, are a class of antibiotics that
are typically used to treat infections caused by gram-positive bacteria and some respiratory tract
infections. They are not the first line of treatment for urinary tract infections.
Choice B rationale:
Sulfonamides Sulfonamides, such as sulfamethoxazole, are often used to treat urinary tract
infections. They work by stopping the growth of bacteria. Sulfonamides are often combined with
other antibiotics like trimethoprim to increase their effectiveness. This combination is
commonly known as co-trimoxazole.
Choice C rationale:
Carbapenems Carbapenems are a class of antibiotics that are usually reserved for serious
infections caused by gram-negative bacteria. While they can be used to treat a variety of
infections, they are not typically the first choice for urinary tract infections.
Choice D rationale:
Tetracyclines Tetracyclines are a group of broad-spectrum antibiotics that are effective against a
wide range of bacteria. However, they are not typically used for urinary tract infections. They are
more commonly used for infections such as acne, chlamydia, and Lyme disease.
Please consult with a healthcare professional for accurate information.
A nurse is discussing the care of a client who has type 1 diabetes mellitus with an
assistive personnel (AP). Which of the following situations should the nurse
instruct the AP to report immediately?
A. The client refuses breakfast and requests to sleep.
B. The client asks the AP to trim his broken toenail.
C. The client reports urine that is dark yellow in color.
D. The client reports dizziness when standing.
RATIONALES
Choice A rationale:
Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ
in the abdomen, produces very little or no insulin. Insulin is a hormone that helps the body to
use glucose for energy. Glucose is a sugar that comes, in large part, from foods we eat. Insulin
allows glucose to enter cells in the body. Therefore, if a client with type 1 diabetes refuses
breakfast and requests to sleep, it could lead to hypoglycemia, a condition characterized by
abnormally low blood glucose levels. Hypoglycemia can cause symptoms such as weakness,
sweating, confusion, and in severe cases, unconsciousness or seizures. It is a medical emergency
and should be reported immediately.
Choice B rationale:
Trimming a toenail may seem like a simple task, but for a person with diabetes, it can lead to
serious complications. Diabetes can cause nerve damage that leads to numbness in the feet,
making it difficult for a person to feel a cut, blister, or sore. These injuries can become infected
and lead to serious complications, such as the need for amputation. However, this situation is
, not as immediately life-threatening as hypoglycemia and does not need to be reported
immediately.
Choice C rationale:
Dark yellow urine can be a sign of dehydration, which can be a concern for individuals with
diabetes. However, it can also be a result of less serious causes such as certain medications,
foods, or simply not drinking enough fluids. While it‟s important for the AP to encourage the
client to drink more fluids, this situation is not as immediately life-threatening as hypoglycemia.
Choice D rationale:
Dizziness when standing, also known as orthostatic hypotension, can be a side effect of some
medications used to treat diabetes. It can also be a symptom of dehydration or other conditions.
While it‟s important for the AP to monitor the client‟s symptoms and report any changes, this
situation is not as immediately life-threatening as hypoglycemia
A nurse is caring for a client who has diabetes insipidus. Which of the following
findings should the nurse expect?
A. Bounding peripheral pulses
B. Moist mucous membranes
C. Bradycardia
D. Decreased urine specific gravity
RATIONALES
Choice A rationale:
Bounding peripheral pulses are not typically associated with diabetes insipidus. Diabetes
insipidus is a condition characterized by excessive thirst and excretion of large amounts of
severely dilute urine.
Choice B rationale:
Moist mucous membranes are not a common finding in diabetes insipidus. In fact, due to
excessive urination, patients may experience dehydration which can lead to dry mucous
membranes.
Choice C rationale:
Bradycardia, or a slower than normal heart rate, is not a typical symptom of diabetes insipidus.
The condition does not directly affect the heart rate.
Choice D rationale:
Decreased urine specific gravity is a key finding in diabetes insipidus. The condition causes an
imbalance of water in the body, leading to the production of large amounts of dilute (or low
specific gravity) urine.
Please note that these rationales are based on general knowledge about diabetes insipidus and
the specific symptoms mentioned in the choices. For a more detailed understanding, it‟s
recommended to refer to medical textbooks or consult with healthcare professionals.
