Nokea
A nurse is explaining to a young mother why she cannot give her 2-year-old child an adult dose of Tylenol. Which of the following statements would indicate that the mother needs further education?
- A. There could be a time when my child may need a higher dose than normal.'
- B. My baby's dose of Tylenol is based on a healthy adult male.'
- C. My baby can't handle a high dose of Tylenol because her liver may be damaged.'
- D. My child's dose of Tylenol should be based on her weight or age.'
Correct Answer: B
Rationale: A child's dose is never based on an adult's dose. However, on rare occasions a child's dose might be higher than normal if a critical concentration cannot be reached with a smaller dose and a higher dose would not be harmful. Benefits from the increased dosage would have to outweigh the risk for adverse or toxic effects. A child's organs may not be mature enough to handle drugs, causing drug metabolism to be altered. A child's dosages are determined by the age, weight, or body surface.
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Hepatitis B vaccine is contraindicated in patients who:
- A. Were born after less than 32 weeks gestation (give first dose at age 6 months)
- B. Are pregnant
- C. Are on hemodialysis
- D. Are allergic to yeast
Correct Answer: D
Rationale: Hepatitis B vaccine is contraindicated in yeast allergy (it's yeast-derived); prematurity , pregnancy , or dialysis are not.
Which statement is not correct about metformin:
- A. Is for internal use only
- B. Reduce weight, apetite
- C. More frequently causes nausea and vomiting comparing with other hypoglicemic drugs
- D. Use for diabetes mellitus type I
Correct Answer: D
Rationale: Metformin is not typically used for type 1 diabetes, which requires insulin, as it acts on insulin sensitivity and hepatic glucose production.
Which of the following is the indication for glucocorticoid prescribing?
- A. Cataract
- B. Prevention of respiratory distress
- C. Hypofunction of thyroid gland
- D. Hypocalcemia
Correct Answer: B
Rationale: Glucocorticoids are used to prevent respiratory distress, particularly in preterm infants, by promoting lung maturation.
Beta blockers are the drugs of choice for exertional angina because they:
- A. Improve myocardial oxygen supply by vasodilating the coronary arteries
- B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: B
Rationale: Beta blockers reduce oxygen demand by lowering heart rate and resistance, not by vasodilation.
A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what?
- 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 status.
- 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 moves to a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen 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.