Medication Case Studies Practice Exam

Case Study 1: Mestinon (Pyridostigmine) for Myasthenia Gravis

Patient: 42-year-old female with myasthenia gravis, prescribed pyridostigmine (Mestinon) 60 mg PO every 4 hours while awake.

Q1. Highlight the assessment findings that are most concerning for a patient on Mestinon:

Q2. Which order should the nurse question?
Administer Mestinon 30 minutes before meals
Monitor for cholinergic crisis
Administer with anticholinergic drugs
Assess for improvement in swallowing

Q3. Select all teaching points for Mestinon:
Take medication at the same time every day
Report increased muscle weakness or difficulty breathing
Recognize signs of cholinergic crisis (excessive salivation, diarrhea, sweating)
Do not double up on missed doses

Q4. Place the following nursing actions in order of priority if the patient develops severe muscle weakness and drooling:

1. --Select--Assess airway and breathingStop MestinonNotify the providerDocument findings
2. --Select--Assess airway and breathingStop MestinonNotify the providerDocument findings
3. --Select--Assess airway and breathingStop MestinonNotify the providerDocument findings
4. --Select--Assess airway and breathingStop MestinonNotify the providerDocument findings

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

Side Effect	Common	Serious
Mild abdominal cramps
Cholinergic crisis
Diarrhea

Q6. Which finding requires immediate provider notification?
Severe muscle weakness and drooling
Mild headache
Mild abdominal cramps

Case Study 2: Reglan (Metoclopramide) for Gastroparesis

Patient: 28-year-old female with diabetic gastroparesis, prescribed metoclopramide (Reglan) 10 mg PO 30 minutes before meals and at bedtime.

Q7. Highlight the assessment findings that are most concerning for a patient on Reglan:

Q8. Which order should the nurse question?
Administer Reglan 30 minutes before meals
Monitor for tardive dyskinesia
Administer with other dopamine antagonists
Assess for sedation

Q9. Select all teaching points for Reglan:
Report involuntary movements or muscle twitching
Avoid alcohol and other CNS depressants
Take 30 minutes before meals
May cause drowsiness

Q10. Place the following nursing actions in order of priority if the patient develops lip smacking and involuntary facial movements:

1. --Select--Stop ReglanAssess for other abnormal movementsNotify the providerDocument findings
2. --Select--Stop ReglanAssess for other abnormal movementsNotify the providerDocument findings
3. --Select--Stop ReglanAssess for other abnormal movementsNotify the providerDocument findings
4. --Select--Stop ReglanAssess for other abnormal movementsNotify the providerDocument findings

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

Side Effect	Common	Serious
Mild diarrhea
Tardive dyskinesia
Sedation

Q12. Which finding requires immediate provider notification?
Lip smacking and involuntary facial movements
Mild diarrhea
Mild headache

Case Study 3: Aricept (Donepezil) for Dementia

Patient: 76-year-old male with mild Alzheimer's dementia, prescribed donepezil (Aricept) 10 mg PO at bedtime.

Q13. Highlight the assessment findings that are most concerning for a patient on Aricept:

Q14. Which order should the nurse question?
Administer Aricept at bedtime
Monitor for bradycardia
Administer with other cholinesterase inhibitors
Assess for GI side effects

Q15. Select all teaching points for Aricept:
Take at bedtime to minimize GI upset
Report fainting, severe nausea, or vomiting
May cause mild diarrhea or insomnia
Do not take with other cholinesterase inhibitors

Q16. Place the following nursing actions in order of priority if the patient develops bradycardia and syncope:

1. --Select--Assess vital signsHold AriceptNotify the providerDocument findings
2. --Select--Assess vital signsHold AriceptNotify the providerDocument findings
3. --Select--Assess vital signsHold AriceptNotify the providerDocument findings
4. --Select--Assess vital signsHold AriceptNotify the providerDocument findings

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

Side Effect	Common	Serious
Mild diarrhea
Bradycardia
Severe nausea and vomiting

Q18. Which finding requires immediate provider notification?
Bradycardia and syncope
Mild insomnia
Mild diarrhea

Case Study 4: Bethanechol for Postoperative Urinary Retention

Patient: 45-year-old male, post-abdominal surgery, prescribed bethanechol 25 mg PO three times daily for urinary retention.

Q19. Highlight the assessment findings that are most concerning for a patient on bethanechol:

Q20. Which order should the nurse question?
Administer bethanechol on an empty stomach
Monitor for bronchospasm
Administer to patient with asthma
Monitor blood pressure and heart rate

Q21. Select all teaching points for bethanechol:
Take on an empty stomach to reduce nausea
Report difficulty breathing or chest tightness
Rise slowly to prevent dizziness
Mild abdominal cramps may occur

Q22. Place the following nursing actions in order of priority if the patient develops wheezing and shortness of breath:

1. --Select--Assess airway and breathingStop bethanecholNotify the providerDocument findings
2. --Select--Assess airway and breathingStop bethanecholNotify the providerDocument findings
3. --Select--Assess airway and breathingStop bethanecholNotify the providerDocument findings
4. --Select--Assess airway and breathingStop bethanecholNotify the providerDocument findings

Q23. Matrix: Indicate if each is a common or serious side effect of bethanechol:

Side Effect	Common	Serious
Mild abdominal cramps
Bronchospasm
Bradycardia

Q24. Which finding requires immediate provider notification?
Wheezing and shortness of breath
Mild abdominal cramps
Increased salivation

Case Study 5: Scopolamine Pre-Operatively

Patient: 62-year-old female scheduled for surgery, prescribed scopolamine transdermal patch 1.5 mg behind the ear pre-operatively for prevention of nausea and vomiting.

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

Q26. Which order should the nurse question?
Apply patch behind the ear 4 hours before surgery
Monitor for anticholinergic side effects
Apply patch to broken skin
Assess for urinary retention

Q27. Select all teaching points for scopolamine:
Wash hands after handling the patch
May cause dry mouth and blurred vision
Report confusion or agitation
Avoid driving until effects are known

Q28. Place the following nursing actions in order of priority if the patient develops confusion and agitation:

1. --Select--Remove the patchAssess mental statusNotify the providerDocument findings
2. --Select--Remove the patchAssess mental statusNotify the providerDocument findings
3. --Select--Remove the patchAssess mental statusNotify the providerDocument findings
4. --Select--Remove the patchAssess mental statusNotify the providerDocument findings

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

Side Effect	Common	Serious
Dry mouth
Confusion
Urinary retention

Q30. Which finding requires immediate provider notification?
Confusion and agitation
Dry mouth
Mild drowsiness

Case Study 6: Oxybutynin for Overactive Bladder

Patient: 55-year-old female with overactive bladder, prescribed oxybutynin 5 mg PO twice daily.

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

Q32. Which order should the nurse question?
Monitor for anticholinergic side effects
Encourage increased fluid and fiber intake
Administer to patient with narrow-angle glaucoma
Assess for urinary retention

Q33. Select all teaching points for oxybutynin:
May cause dry mouth and blurred vision
Report hallucinations or confusion
Increase fluid and fiber to prevent constipation
Avoid overheating and excessive exercise

Q34. Place the following nursing actions in order of priority if the patient develops hallucinations and severe constipation:

1. --Select--Hold oxybutyninAssess mental status and bowel functionNotify the providerDocument findings
2. --Select--Hold oxybutyninAssess mental status and bowel functionNotify the providerDocument findings
3. --Select--Hold oxybutyninAssess mental status and bowel functionNotify the providerDocument findings
4. --Select--Hold oxybutyninAssess mental status and bowel functionNotify the providerDocument findings

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

Side Effect	Common	Serious
Dry mouth
Hallucinations
Severe constipation

Q36. Which finding requires immediate provider notification?
Hallucinations and severe constipation
Dry mouth
Mild blurred vision