Nokea
A client has just been prescribed with methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to?
- A. Clay-colored stool is a normal response to the treatment.
- B. Pregnancy is not contraindicated with the use of the medication.
- C. Strict hand washing.
- D. Get a daily source of sunlight during the day.
Correct Answer: C
Rationale: Methotrexate is an immunosuppressant, increasing the risk of infections. Strict hand washing and infection prevention measures are crucial. Clay-colored stools are not normal and may indicate liver dysfunction. Pregnancy is contraindicated due to the risk of fetal harm. Sunlight exposure should be limited to reduce the risk of photosensitivity reactions.
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The nurse administers IV push hydralazine (Apresoline) to a client with severe hypertension. Which assessment finding requires immediate action?
- A. Blood pressure of 140/90 mmHg
- B. Heart rate of 110 beats per minute
- C. Headache
- D. Flushing
Correct Answer: B
Rationale: Hydralazine, a vasodilator, lowers blood pressure but triggers reflex tachycardia. A heart rate of 110 bpm indicates significant compensation, risking ischemia or strain, requiring immediate action (e.g., slowing infusion, notifying physician). BP of 140/90 is improved, not critical. Headache and flushing are expected from vasodilation, less urgent. Tachycardia's potential to destabilize circulation, especially in severe hypertension, aligns with hydralazine's pharmacology'arteriolar relaxation prompts sympathetic response. This finding demands swift intervention to prevent cardiovascular collapse, making B the priority over manageable side effects.
Depression that occurs during cold winter months would be classified as
- A. baby blues
- B. bipolar disorder
- C. seasonal affective disorder
- D. obsessive-compulsive disorder
Correct Answer: C
Rationale: Seasonal affective disorder (SAD) ties depression to winter-less light, per psychiatry-unlike baby blues (postpartum), bipolar (cycles), or OCD (obsessions). SAD's seasonal link defines it, matching symptoms.
Which of the following is NOT an opioid or NSAID?
- A. Morphine
- B. Ibuprofen
- C. Hydromorpho
- D. Acetaminoph en
Correct Answer: D
Rationale: Acetaminophen is not an opioid or NSAID. It is a pain reliever and fever reducer, but it works in a different way compared to opioids and NSAIDs. Unlike opioids, acetaminophen does not have the same risk of physical dependence or addiction. And unlike NSAIDs, acetaminophen does not have anti-inflammatory properties. It is often used for mild to moderate pain relief and as a fever reducer. Be cautious when taking acetaminophen, as high doses can be harmful to the liver.
A 48-year-old woman pricks her finger on a rose bush while pruning. A few days later, she develops small, red lesions near the wound and a red track ascending her hand toward her trunk. Her doctor prescribes itraconazole for the sporotrichosis. What is the mechanism of action of this medication?
- A. Disrupts fungal cell membrane by forming pores (nystatin, amphotericin B)
- B. Disrupts fungal microtubules (griseofulvin)
- C. Inhibits conversion of lanosterol to ergosterol
- D. Inhibits squalene monooxygenase (terbinafine)
Correct Answer: C
Rationale: Sporotrichosis, from Sporothrix schenckii, requires antifungals like itraconazole. Option , inhibiting lanosterol to ergosterol conversion, is correct-itraconazole blocks 14-α-demethylase, disrupting fungal membrane synthesis. Option , pore formation, is amphotericin B's mechanism. Option , microtubule disruption, is griseofulvin's. Option , squalene monooxygenase inhibition, is terbinafine's. Option (E), 5-FU conversion, is flucytosine's. Itraconazole's ergosterol inhibition effectively treats this subcutaneous infection, targeting fungal viability.
If you inject a drug with a pH of 6.5 and pka of 8.1 into a tissue with a pH of 7.4, to what extent would you expect this drug to be ionized in the tissue?
- A. over 50%
- B. 50%
- C. under 50%
- D. 100%
Correct Answer: A
Rationale: The percentage of ionization of a weak acid or base can be estimated using the Henderson-Hasselbalch equation: