Nokea
A 59-year-old man with a history of depression cuts his wrists in a suicide attempt. He is brought to the local emergency department for care. He has bilateral medial 3-cm lacerations through the skin and subcutaneous tissues that will require sutures. A review of his prior medical history indicates an allergy to 2% lidocaine. The most likely explanation for this is which of the following?
- A. Allergic
- B. Mast cell mediated
- C. Neurogenic
- D. Psychogenic
Correct Answer: A
Rationale: Lidocaine allergy causing an issue with suturing suggests an allergic reaction , likely IgE-mediated (overlapping with B, but A is broader). Neurogenic , psychogenic , and vascular (E) don't fit. True local anesthetic allergies are rare but explain this history.
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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.
What is a side effect of Heparin?
- A. nausea
- B. diarrhea
- C. bleeding
- D. bronchospasms
Correct Answer: C
Rationale: Heparin is an anticoagulant medication that works by preventing the formation of blood clots. One of the main side effects of heparin therapy is an increased risk of bleeding. Since heparin inhibits the body's ability to clot blood, it can lead to easy bruising, nosebleeds, gastrointestinal bleeding, or bleeding at the injection site. Patients on heparin therapy must be closely monitored for signs of bleeding, and their dosage may need to be adjusted to minimize this risk.
The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
- A. Increased heart rate
- B. Increased blood vessel dilation
- C. Increased force of cardiac contractions
- D. Increased conduction of electrical impulses across the heart
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor that works by increasing the levels of cyclic adenosine monophosphate (cAMP) within cardiac myocytes. This leads to enhanced calcium influx into the cells, ultimately resulting in increased force of cardiac contractions (positive inotropic effect). This increased contractility helps improve cardiac output without necessarily increasing heart rate or affecting blood vessel dilation.
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.
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: