Nokea
A 57-year-old man was recently diagnosed with Type-2 diabetes mellitus and placed on a medication. He began having myalgias and feeling sick and later developed respiratory distress, so he went to the hospital. His pH was 7.2, and he had elevated blood lactate levels. Which drug is likely causing his problem?
- A. Acarbose
- B. Glyburide
- C. Metformin
- D. Pioglitazone
Correct Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect, presenting with low pH and elevated lactate levels.
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The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patient's sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action?
- A. Add ethambutol (Myambutol)
- B. Change the streptomycin to clarithromycin
- C. Change the streptomycin to kanamycin
- D. Order renal function tests
Correct Answer: C
Rationale: Kanamycin replaces streptomycin in phase I resistance; ethambutol is for INH resistance, and clarithromycin is phase II. The patient's current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin.
Bisphosphonates treat or prevent osteoporosis by:
- A. Inhibiting osteoclastic activity
- B. Fostering bone resorption
- C. Enhancing calcium uptake in the bone
- D. Strengthening the osteoclastic proton pump
Correct Answer: A
Rationale: Bisphosphonates inhibit osteoclasts, reducing bone resorption; they don't foster resorption or enhance uptake .
Patients who are prescribed olanzapine (Zyprexa) should be monitored for:
- A. Insomnia
- B. Weight gain
- C. Hypertension
- D. Galactorrhea
Correct Answer: B
Rationale: Olanzapine commonly causes significant weight gain.
If the measles, mumps, rubella, and varicella (MMRV) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the CDC recommends:
- A. Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella two-shot regimen
- B. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity
- C. Patients be premedicated with acetaminophen 15 minutes before the vaccine is given
- D. Patients should not be around pregnant women for the first 48 hours after the vaccine is given
Correct Answer: A
Rationale: MMRV has higher fever/seizure risk vs. separate shots, per CDC; second dose isn't mandated as MMRV.
A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for a __ adverse drug reaction when he no longer requires the opioids.
- A. Rapid
- B. First-dose
- C. Late
- D. Delayed
Correct Answer: A
Rationale: Opioid withdrawal after heavy use is a Type E (end-of-use) ADR, but 'Rapid' fits the abrupt cessation context here, though not standard typology.