Nokea
Drugs significantly affected by enzyme induction include the following except:
- A. Barbiturate
- B. Chlorpromazine
- C. Diphenyl hydantoin
- D. Warfarin
Correct Answer: B
Rationale: Barbiturates, phenytoin (diphenyl hydantoin), and warfarin are affected by enzyme induction; chlorpromazine is less so.
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The home health nurse is caring for a 77-year-old patient with congestive heart failure. What would the nurse consider a priority to assess to develop the most effective plan of care related to medication administration?
- A. Description of the patient's living environment
- B. Required lifestyle changes
- C. Family members in the community
- D. Compliance with therapy to reduce risk of skin breakdown
Correct Answer: A
Rationale: Living environment affects medication storage, access, and administration, critical for an elderly patient with CHF.
Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?
- A. A 35-year-old woman with cervical cancer
- B. A 41-year-old man with kidney stones
- C. A 50-year-old man with cirrhosis of the liver
- D. A 62-year-old woman in acute renal failure
Correct Answer: C
Rationale: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.
Which of the following adverse effects are less likely in a beta1-selective blocker?
- A. Dysrhythmias
- B. Impaired insulin release
- C. Reflex orthostatic changes
- D. Decreased triglycerides and cholesterol
Correct Answer: B
Rationale: Beta1-selective blockers (e.g., atenolol) have less impact on insulin release compared to non-selective blockers.
Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
- A. Black tarry stools
- B. Vomiting
- C. Tremors
- D. Tinnitus
Correct Answer: D
Rationale: Tinnitus is an early aspirin toxicity sign; black stools or vomiting are later.
Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:
- A. Ibuprofen 400 mg three times a day
- B. Acetaminophen, not to exceed 4 grams per day
- C. Prescribe acetaminophen with codeine
- D. Aspirin 640 mg three times a day
Correct Answer: B
Rationale: Acetaminophen is safest with warfarin, avoiding bleeding risks from ibuprofen or aspirin ; codeine is unnecessary for minor pain.