| Course | NU648 Specialized Pharmacology for the AGACNP |
|---|---|
| Unit | Unit 7 |
| Paper type | QT risk review |
| Length | About 950 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU648 Unit 7
Four Drugs, One QTc of 498: A QT Risk Review for an 81-Year-Old Woman With Heart Failure and Pneumonia
[Student Name]
Purdue University Global
NU648: Specialized Pharmacology for the AGACNP
Unit 7 QT Risk Review
[Instructor Name]
[Date]
The patient is composite; intervals, doses and laboratory values are bracketed, and every change is agreed with the admitting team.
The Patient and the ECG
Mrs. [H.] is an [81]-year-old woman with heart failure (her last echocardiogram showed an ejection fraction of [35] percent) and mild Alzheimer disease. She was admitted from home with community-acquired pneumonia. Her admission ECG showed sinus rhythm at [88] beats per minute and a QTc of [498] ms by Fridericia's correction, up from [452] ms on an outpatient tracing [five] months ago. Her potassium was [3.3] mEq/L and her magnesium [1.6] mg/dL after [two] days of poor intake on her usual furosemide.
Four drugs on her current orders can lengthen the QT interval:
1. Azithromycin [500 mg] daily with ceftriaxone for pneumonia, started in the emergency department.
2. Ondansetron [4 mg] intravenously every [eight] hours as needed for nausea, given [three] times since admission.
3. Haloperidol [0.5 mg] intravenously as needed at night for agitation, ordered on the first evening.
4. Donepezil [10 mg] nightly, a home medication for her memory.
Scoring the Risk
The Tisdale score was built to predict QTc prolongation in hospitalized patients and sorts totals into low (0 to 6), moderate (7 to 10) and high (11 to 21) risk (Tisdale et al., 2013). Her points:
1. Age over 68: 1.
2. Female sex: 1.
3. Loop diuretic: 1.
4. Potassium below 3.5 mEq/L: 2.
5. Admission QTc above 450 ms: 2.
6. Heart failure with reduced ejection fraction: 3.
7. At least one QT-prolonging drug: 3.
8. Two or more QT-prolonging drugs at once: 3.
Her total is 16, in the high-risk range. In the validation group, about 73 percent of high-risk patients went on to QTc prolongation. The score was developed in cardiac care units, and she is on a medical ward, so the review treats the number as a strong signal rather than a precise probability.
A high score means the review acts on several contributors at once instead of choosing the single most suspicious drug.
Judging Each Drug
Each drug is put through the same three questions, in the same order. Is it needed? Is there a lower-risk alternative for the same purpose? If it must continue, what monitoring makes that acceptable? The questions explain why four drugs end with four different decisions.
Haloperidol fails the first question. Nighttime agitation in an older adult with dementia usually has a cause worth looking for, and the review asks nursing to start delirium prevention measures: a lit clock, glasses and hearing aids on, a family member at the bedside in the evening, and uninterrupted sleep between [midnight] and [5 a.m.]. Intravenous haloperidol is a recognized cause of torsade de pointes in hospital settings, and the risk rises with a long baseline QT and low potassium (Drew et al., 2010). Decision: discontinue.
Azithromycin passes the first question, since atypical coverage is part of standard inpatient pneumonia treatment, but fails the second. The ATS and IDSA guideline pairs a beta-lactam with a macrolide for most inpatients and offers doxycycline as the alternative partner when a macrolide is a problem (Metlay et al., 2019). A respiratory fluoroquinolone would also lengthen the QT, so it is not an alternative here. In a large Medicaid cohort, azithromycin carried a small absolute increase in cardiovascular death that was greatest in patients at high baseline cardiovascular risk (Ray et al., 2012), and she is one of them. Decision: replace with doxycycline [100 mg] twice daily, continue ceftriaxone.
Ondansetron also fails the second question, but differently. Her nausea began with constipation, no bowel movement for [four] days, and the review treats the cause. Decision: stop ondansetron, start a bowel regimen, and reassess nausea in [24] hours before choosing any antiemetic.
Donepezil passes all three questions. It supports her cognition, stopping it could worsen her confusion in the hospital, and its effect on the QT interval can be monitored. Decision: continue, with a repeat ECG.
Correcting What Can Be Corrected
Potassium and magnesium are the fastest contributors to change. The review asks for potassium replacement to a target of at least [4.0] mEq/L and a magnesium level of [2.0] mg/dL or higher, with both rechecked the next morning. Her furosemide is continued, because her heart failure needs it, but the team will check her weight and potassium daily while her intake is poor. Heart failure itself cannot be removed from the score, which is one more reason to remove what can be removed.
Monitoring Plan
1. Repeat 12-lead ECG [four] hours after the first potassium and magnesium doses and again on the morning of [Day 2].
2. Continuous telemetry while the QTc stays above [470] ms.
3. If the QTc rises above 500 ms or by more than 60 ms from her baseline, the team is paged and every QT-prolonging drug is reviewed again, including donepezil. The AHA and ACCF statement treats these thresholds as the point of substantial risk (Drew et al., 2010).
4. Nursing is taught to report palpitations, dizziness or fainting at once.
Summary for the Team
Mrs. [H.] has a high-risk Tisdale score driven by her age, sex, heart failure, a low potassium and four QT-prolonging drugs. Haloperidol stops, azithromycin becomes doxycycline, ondansetron stops while her constipation is treated, and donepezil continues under monitoring. Potassium and magnesium are corrected today. If her next ECG shows the QTc falling toward her baseline, the review has done its job.
References
Drew, B. J., Ackerman, M. J., Funk, M., Gibler, W. B., Kligfield, P., Menon, V., Philippides, G. J., Roden, D. M., & Zareba, W. (2010). Prevention of torsade de pointes in hospital settings: A scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation, 121(8), 1047-1060. https://doi.org/10.1161/CIRCULATIONAHA.109.192704
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581ST
Ray, W. A., Murray, K. T., Hall, K., Arbogast, P. G., & Stein, C. M. (2012). Azithromycin and the risk of cardiovascular death. New England Journal of Medicine, 366(20), 1881-1890. https://doi.org/10.1056/NEJMoa1003833
Tisdale, J. E., Jaynes, H. A., Kingery, J. R., Mourad, N. A., Trujillo, T. N., Overholser, B. R., & Kovacs, R. J. (2013). Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circulation: Cardiovascular Quality and Outcomes, 6(4), 479-487. https://doi.org/10.1161/CIRCOUTCOMES.113.000152
Reading the NU 648 Unit 7 instructions
The Unit 7 assignment presents a hospitalized patient with a prolonged QTc and several medications that may be contributing. You are asked to assess risk with a validated tool, identify each QT-prolonging drug, decide what to do with each one, correct modifiable contributors and write a monitoring plan with thresholds for action. The correction formula should be named, since Bazett and Fridericia give different numbers at faster heart rates. The usual length is three to four pages, and the AHA and ACCF statement on torsade de pointes is the expected anchor source. Decisions should be specific to this patient; a general list of risky drugs does not meet the instructions.
How the NU 648 Unit 7 example is put together
The example starts with the ECG, the electrolytes and a numbered list of the four drugs with doses and indications. The Tisdale score follows item by item, with a note that the tool was built in cardiac care units and she is on a medical ward. Each drug is then judged by the same three questions: whether it is needed, whether a lower-risk alternative exists and what monitoring would make it acceptable. That order produces four different outcomes. Electrolyte targets and the diuretic get their own section. The monitoring plan names repeat ECG times, telemetry and the 500 ms and 60 ms thresholds.
NU648 Unit 7 rubric: what earns full points
The Unit 7 rubric gives points for risk assessment, drug-by-drug decisions, use of evidence, correction of contributors and the monitoring plan. Risk assessment earns full credit when every score item is shown and matched to the chart. Decisions are judged on whether each has a reason and an alternative, not only a stop. Evidence counts when it fits the decision, such as the CAP guideline for replacing azithromycin and the Medicaid cohort for its cardiac risk. Correction of potassium and magnesium is its own criterion. Monitoring earns full points when it states when to recheck and what number triggers a call. A short summary for the team at the end, one sentence per drug, also helps the grader confirm that every decision was made.
Common NU648 Unit 7 mistakes, and how to avoid them
Many reviews stop every QT-prolonging drug at once, which can leave an infection untreated or a patient more confused. Another mistake is replacing azithromycin with a fluoroquinolone, which trades one QT risk for another. Students often report the QTc without naming the correction formula. The Tisdale score is frequently totaled wrong because the one-drug and two-or-more items are scored separately. Electrolytes are mentioned but not given targets. Finally, monitoring plans often say to watch closely without a number, and a threshold that triggers action is what the rubric looks for. Put a date on the next ECG, not only an intention to repeat one.
Get an NU648 Unit 7 example written to your instructions
Pass along the NU648 Unit 7 medication list with the ECG values, electrolytes and rubric. At no cost as a first order and typically ready within 24-48h, the sample scores the patient's risk before touching any drug, then gives each QT-prolonging agent its own reasoned outcome, with monitoring and a threshold for action. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU648 Unit 7 questions, answered
Should the review use Bazett or Fridericia?
Fridericia is generally preferred when the heart rate is fast or slow, because Bazett overcorrects at higher rates and can make a normal interval look prolonged. Many ECG machines report Bazett by default. The sample names the correction used, gives the reason, and recalculates if the case supplies only one version.
Does every high-risk patient need telemetry?
Not necessarily. The AHA/ACCF statement describes indications for QT monitoring in hospital settings, and they depend on the drugs, the baseline interval and the clinical setting. The sample describes the monitoring its composite patient would warrant, with the source, and leaves actual monitoring orders to the clinicians responsible for her care.
Where can I find a free NU648 Unit 7 sample paper?
This page holds the full NU648 Unit 7 QT risk review, with the Tisdale score shown item by item, four drug decisions and a monitoring plan. For a different patient or drug list, you can ask for a free sample written to your own case.
How is the Tisdale score calculated in NU648 Unit 7?
Points are given for age over 68, female sex, a loop diuretic, low potassium, an admission QTc over 450 ms, acute myocardial infarction, septic shock, heart failure, one QT-prolonging drug and two or more such drugs. Totals of 11 to 21 are high risk. The sample scores 16.
What replaces azithromycin for pneumonia when the QTc is long?
The sample uses doxycycline with ceftriaxone, the alternative the ATS and IDSA guideline offers when a macrolide is a problem. A respiratory fluoroquinolone is not used, because it also lengthens the QT interval.