Nokea
The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
- A. Hematocrit levels start to rise
- B. Hemoglobin levels return to normal
- C. Reticulocyte count begins to rise
- D. Vitamin B12 levels return to normal
Correct Answer: C
Rationale: Reticulocyte count rise signals early bone marrow response to B12, preceding hemoglobin or hematocrit increases.
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Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
- A. A bisphosphonate
- B. Calcium supplementation
- C. Vitamin D
- D. All of the above
Correct Answer: D
Rationale: All mitigate prednisone's bone loss: bisphosphonates , calcium , and vitamin D .
Ginseng, which is taken to assist with memory, may potentiate:
- A. Aricept
- B. Insulin
- C. Digoxin
- D. Propranolol
Correct Answer: C
Rationale: Ginseng can increase digoxin levels, potentially leading to toxicity.
A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug?
- A. Alcohol
- B. Cocaine
- C. LSD
- D. Methamphetamine
Correct Answer: B
Rationale: Cocaine causes stimulant psychosis with visual (lights) and tactile (bugs) hallucinations; LSD differs in effect. A stimulant psychosis can occur with chronic use of any stimulant and, with cocaine, progresses to visual hallucinations of colored lights and tactile hallucinations of bugs crawling under the skin.
Glucocorticoids:
- A. Decrease amount of immunocompetent cells and macrophages in the blood
- B. Stimulate activity of macrophages and monocytes
- C. Increase amount of T lymphocytes
- D. Stimulate production of antibodies
Correct Answer: A
Rationale: Glucocorticoids reduce immunocompetent cells and macrophages, contributing to their immunosuppressive effects.
A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no side effects. Since her move, however, she reports having 'dizzy spells and weakness' and feels that the drug is no longer effective. The nurse knows that one possible reason for the change in the effectiveness of the drug could be which of the following?
- A. The impact of the placebo effect on the patient's response
- B. The accumulative effect of the drug if it has been taken for many years
- C. The impact of the warmer environment on the patient's physical state
- D. Problems with patient compliance with the drug regimen while on vacation
Correct Answer: C
Rationale: Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and feelings of weakness. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen while on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue.