Nokea
Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
- A. Fluoxetine (Prozac)
- B. Paroxetine (Paxil)
- C. Amitriptyline (Elavil)
- D. Duloxetine (Cymbalta)
Correct Answer: D
Rationale: Duloxetine addresses both depression and fatigue, unlike sedating options.
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Which of the following stimulated production of thyroid hormones:
- A. Thyrotropic hormone
- B. Corticosteroids
- C. Dopamine
- D. Somatostatine
Correct Answer: A
Rationale: Thyrotropic hormone (TSH) stimulates the thyroid to produce T3 and T4.
The nursing instructor is discussing drug therapy in the older adult. What would the instructor tell the students could affect therapeutic dosing in an older adult?
- A. In older adults, drugs have decreased GI absorption.
- B. In older adults
- C. In older adults, drugs are distributed to a smaller portion of the tissue.
- D. In older adults, drugs have an increased action.
Correct Answer: A
Rationale: Decreased GI absorption in older adults can reduce drug bioavailability, necessitating dosage adjustments.
A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this is due to:
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
A nurse is teaching a client who has a new prescription for Ramelteon. The nurse should instruct the client to avoid which of the following foods while taking this medication?
- A. Baked potato
- B. Fried chicken
- C. Whole-grain bread
- D. Citrus fruits
Correct Answer: B
Rationale: High-fat foods like fried chicken can delay ramelteon's onset, a melatonin receptor agonist.
Following is the example of second generation antihistaminic:
- A. Diphenhydramine
- B. Promethazine
- C. Chlorpheniramine
- D. Cetirizine
Correct Answer: D
Rationale: Cetirizine is a second-generation antihistamine with less sedation due to reduced CNS penetration, unlike first-generation drugs like diphenhydramine, promethazine, and chlorpheniramine.