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A 35-year-old woman has Graves' disease, a small goiter, and symptoms that are deemed 'mild-to-moderate.' Propylthiouracil is prescribed. Which of the following is the most serious adverse response to this drug, for which close monitoring is required?
- A. Agranulocytosis
- B. Cholestatic jaundice
- C. Gout
- D. Renal tubular necrosis
Correct Answer: A
Rationale: Agranulocytosis is a severe, potentially fatal side effect of propylthiouracil requiring close monitoring due to its impact on white blood cell production.
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Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:
- A. Understanding that obesity is a contraindication to prescribing phentermine
- B. Anorexiants may cause tolerance and should only be prescribed for 6 months
- C. Patients should be monitored for postural hypotension
- D. Renal function should be monitored closely while on anorexiants
Correct Answer: C
Rationale: Phentermine can cause postural hypotension, requiring monitoring.
As an antacid, sodium bicarbonate has the following disadvantages EXCEPT:
- A. It causes acid rebound
- B. In ulcer patients, it increases risk of perforation
- C. It has low acid neutralizing capacity
- D. It is contraindicated in CHF
Correct Answer: C
Rationale: Sodium bicarbonate has high acid-neutralizing capacity, but it causes acid rebound, risks perforation in ulcers due to gas production, and is contraindicated in CHF due to sodium load.
A 25-year-old woman comes to the clinic complaining of rapid heart rate and easy fatigability. Laboratory results reveal low hemoglobin levels and microcytic red blood cells. The most suitable therapy for her condition will be:
- A. Folic acid
- B. Epoiten alfa
- C. Ferrous sulfate
- D. Vitamin B12
Correct Answer: C
Rationale: Microcytic anemia suggests iron deficiency; ferrous sulfate is the standard treatment.
A nurse in a provider's office is reviewing the medical record of a client who is pregnant and is at her first prenatal visit. Which of the following immunizations may the nurse administer safely to this client?
- A. Varicella vaccine
- B. Rubella vaccine
- C. Inactivated influenza vaccine
- D. Measles vaccine
Correct Answer: C
Rationale: Inactivated influenza vaccine is safe in pregnancy; live vaccines (A, B, D) are contraindicated.
Adherence to beta blocker therapy may be affected by their:
- A. Short half-lives requiring twice daily dosing
- B. Tendency to elevate lipid levels
- C. Effects on the male genitalia, which may produce impotence
- D. None of the above
Correct Answer: C
Rationale: Impotence is a known side effect that can reduce adherence to beta blockers.