Medication Case Studies Practice Exam

Case Study 1: Pepcid (Famotidine) for Chronic GERD

Patient: 58-year-old female with chronic GERD, taking Pepcid (famotidine) 20 mg twice daily for 6 months. She reports increasing fatigue and new numbness and tingling in her feet.

Q1. Highlight the assessment findings most concerning for a patient on Pepcid:

Q2. Which order should the nurse question?
Monitor for allergic reaction Advise patient to avoid NSAIDs if possible Continue Pepcid if new rash or breathing problems develop Take Pepcid with or without food
Q3. Select all teaching points for Pepcid:
Report new fatigue, pallor, or numbness/tingling in hands or feet Avoid alcohol and NSAIDs to reduce further GI irritation May cause headache or mild constipation Take at the same time each day for best results
Q4. Place the following nursing actions in order of priority if the patient develops SOB or chest pain:

1. --Select--Assess for symptoms of anaphylaxisNotify the providerHold medicationDocument findings
2. --Select--Assess for symptoms of anaphylaxisNotify the providerHold medicationDocument findings
3. --Select--Assess for symptoms of anaphylaxisNotify the providerHold medicationDocument findings
4. --Select--Assess for symptoms of anaphylaxisNotify the providerHold medicationDocument findings

Q5. Matrix: Indicate if each is a common or serious side effect of Pepcid:

Side Effect	Common	Serious
Headache
Neuropathy
SOB and Chest pain

Q6. Which finding requires immediate provider notification?
SOB and Chest pain Headache Mild constipation

Case Study 2: Omeprazole for Long-term Reflux/Ulcer Prevention

Patient: 72-year-old male taking omeprazole 20 mg daily for chronic reflux. He reports muscle cramps, fatigue, and recent dizziness when standing up quickly.

Q7. Highlight the assessment findings most concerning for a patient on omeprazole:

Q8. Which order should the nurse question?
Monitor for hypomagnesemia in patients on long-term therapy Administer omeprazole before breakfast Continue omeprazole if new muscle cramps and dizziness develop Monitor for diarrhea
Q9. Select all teaching points for omeprazole:
Report new muscle cramps, fatigue, pallor, or dizziness Take 30-60 minutes before meals, preferably in the morning May cause mild diarrhea or headache Long-term use may lower magnesium or vitamin B12
Q10. Place the following nursing actions in order of priority if the patient develops muscle cramps and dizziness:

1. --Select--Assess for symptoms of hypomagnesemiaNotify the providerhold medicationDocument findings
2. --Select--Assess for symptoms of hypomagnesemiaNotify the providerhold medicationDocument findings
3. --Select--Assess for symptoms of hypomagnesemiaNotify the providerhold medicationDocument findings
4. --Select--Assess for symptoms of hypomagnesemiaNotify the providerhold medicationDocument findings

Q11. Matrix: Indicate if each is a common or serious side effect of omeprazole:

Side Effect	Common	Serious
Mild diarrhea
Muscle cramps (hypomagnesemia)
Fatigue, pallor, numbness/tingling (B12 deficiency)

Q12. Which finding requires immediate provider notification?
Muscle cramps, fatigue, pallor, or new dizziness Mild diarrhea Headache

Case Study 3: Sucralfate for Peptic Ulcer

Patient: 49-year-old female with a history of peptic ulcers, prescribed sucralfate 1 g by mouth before meals and at bedtime. She now complains of constipation and difficulty swallowing pills.

Q13. Highlight the assessment findings most concerning for a patient on sucralfate:

Q14. Which order should the nurse question?
Administer sucralfate on an empty stomach Crush and dissolve tablets for patients with difficulty swallowing Administer sucralfate with elevated glucose levels Monitor for constipation
Q15. Select all teaching points for sucralfate:
Take on an empty stomach, 1 hour before meals and at bedtime May cause constipation; increase fluids and fiber Let your provider know if you cannot swallow tablets Separate sucralfate and other medications by at least 2 hours
Q16. Place the following nursing actions in order of priority if the patient cannot swallow the tablet:

1. --Select--Assess swallowing abilityNotify providerCheck if tablet can be crushedDocument
2. --Select--Assess swallowing abilityNotify providerCheck if tablet can be crushedDocument
3. --Select--Assess swallowing abilityNotify providerCheck if tablet can be crushedDocument
4. --Select--Assess swallowing abilityNotify providerCheck if tablet can be crushedDocument

Q17. Matrix: Indicate if each is a common or serious side effect of sucralfate:

Side Effect	Common	Serious
Constipation
Difficulty swallowing tablets
Hyperglycemia

Q18. Which finding requires immediate provider notification?
Hyperglycemia Constipation Dry mouth

Case Study 4: Pepto-Bismol (Bismuth Subsalicylate) OTC for Traveler's Diarrhea

Patient: 40-year-old adult traveling abroad, taking Pepto-Bismol (bismuth subsalicylate) OTC for traveler’s diarrhea.

Q19. Highlight the assessment findings that are most concerning for a patient on Pepto-Bismol:

Q20. Which order should the nurse question?
Advise patient that black tongue and dark stools are harmless Monitor for signs of salicylate toxicity Continue Pepto-Bismol if bloody stools develop Advise patient to avoid if allergic to aspirin
Q21. Select all teaching points for Pepto-Bismol:
Report ringing in the ears or bloody stools May cause harmless black tongue or dark stools Avoid if allergic to aspirin or on anticoagulants Do not use in children or teens with viral illness
Q22. Place the following nursing actions in order of priority if the patient develops bloody stools:

1. --Select--Stop Pepto-BismolAssess for GI bleedingNotify the providerDocument findings
2. --Select--Stop Pepto-BismolAssess for GI bleedingNotify the providerDocument findings
3. --Select--Stop Pepto-BismolAssess for GI bleedingNotify the providerDocument findings
4. --Select--Stop Pepto-BismolAssess for GI bleedingNotify the providerDocument findings

Q23. Matrix: Indicate if each is a common or serious side effect of Pepto-Bismol:

Side Effect	Common	Serious
Black tongue
Tinnitus (ringing in ears)
Bloody stools

Q24. Which finding requires immediate provider notification?
Bloody stools Black tongue Mild constipation

Case Study 5: Compazine (Prochlorperazine) IV for Nausea

Patient: 55-year-old female receiving Compazine (prochlorperazine) IV for severe nausea.

Q25. Highlight the assessment findings that are most concerning for a patient on Compazine:

Q26. Which order should the nurse question?
Monitor for extrapyramidal symptoms Monitor for sedation Continue Compazine if muscle rigidity develops Monitor for orthostatic hypotension
Q27. Select all teaching points for Compazine:
Report muscle stiffness, restlessness, or abnormal movements May cause drowsiness or dry mouth Change positions slowly to avoid dizziness Avoid driving until response is known
Q28. Place the following nursing actions in order of priority if the patient develops muscle rigidity and lip smacking:

1. --Select--Stop CompazineAssess for EPSNotify providerDocument
2. --Select--Stop CompazineAssess for EPSNotify providerDocument
3. --Select--Stop CompazineAssess for EPSNotify providerDocument
4. --Select--Stop CompazineAssess for EPSNotify providerDocument

Q29. Matrix: Indicate if each is a common or serious side effect of Compazine:

Side Effect	Common	Serious
Drowsiness
Muscle rigidity
Lip smacking

Q30. Which finding requires immediate provider notification?
Muscle rigidity and lip smacking Drowsiness Mild dry mouth

Case Study 6: Zofran (Ondansetron) IV for Nausea

Patient: 45-year-old male receiving Zofran (ondansetron) IV for postoperative nausea.

Q31. Highlight the assessment findings that are most concerning for a patient on Zofran:

Q32. Which order should the nurse question?
Monitor for headache and constipation Monitor ECG in patients with cardiac risk Continue Zofran if patient develops palpitations and dizziness Monitor for serotonin syndrome if on other serotonergic drugs
Q33. Select all teaching points for Zofran:
Report palpitations, dizziness, or fainting May cause headache or constipation Change positions slowly to avoid dizziness Notify provider if taking other drugs that affect heart rhythm
Q34. Place the following nursing actions in order of priority if the patient develops palpitations and dizziness:

1. --Select--Stop ZofranAssess ECGNotify providerDocument
2. --Select--Stop ZofranAssess ECGNotify providerDocument
3. --Select--Stop ZofranAssess ECGNotify providerDocument
4. --Select--Stop ZofranAssess ECGNotify providerDocument

Q35. Matrix: Indicate if each is a common or serious side effect of Zofran:

Side Effect	Common	Serious
Headache
Prolonged QT interval
Constipation

Q36. Which finding requires immediate provider notification?
Palpitations and dizziness Headache Constipation