Nokea
A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred vision. He is currently on digoxin for the treatment of heart failure. On physical exam, his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which parameter is used to indicate the ability of digoxin to produce the desired effect relative to a toxic effect?
- A. Bioavailability
- B. Efficacy
- C. Intrinsic activity
- D. Therapeutic index
Correct Answer: D
Rationale: Therapeutic index (TI) measures the relative safety of a drug by comparing the dose required for a therapeutic effect to the dose that produces toxicity. In this case, digoxin toxicity is indicated by the elevated level, and TI is the relevant parameter.
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When reviewing the phases of drug development, the nurse finds a discussion about the postmarketing surveillance phase. Which one of the following activities would the nurse expect to find as being carried out during this phase?
- A. Health care providers report adverse effects to FDA.
- B. Healthy volunteers are involved in the test.
- C. In vitro tests are performed using human cells.
- D. The drug is given to patients with the disease.
Correct Answer: A
Rationale: The postmarketing surveillance phase of drug development encourages health care professionals to report adverse effects of drugs to the FDA using MedWatch. Phase 1 of clinical testing involves 20 to 100 healthy volunteers. In vitro testing of the drug on human or animal cells is done in the pre-FDA phase. In Phase 2 of clinical testing, the drug is given to patients with the disease for which the drug is manufactured.
When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:
- A. The medication may cause sedation and they should not drive.
- B. Constipation is a common side effect and they should increase fluids and fiber.
- C. Patients should not take any other acetaminophen-containing medications at the same time.
- D. All of the above
Correct Answer: D
Rationale: All are critical: sedation, constipation, and acetaminophen overdose risks.
Hepatitis B immune globulin is administered to provide passive immunity to:
- A. Infants born to HBsAg-positive mothers
- B. Household contacts of hepatitis-B virus infected people
- C. Persons exposed to blood containing hepatitis B virus
- D. All of the above
Correct Answer: D
Rationale: Hepatitis B immune globulin provides passive immunity in all listed exposure scenarios .
When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
- A. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia
- B. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents
- C. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins
- D. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime
Correct Answer: D
Rationale: NPH at bedtime targets postprandial hyperglycemia in type 2 diabetes; premixed insulins vary in efficacy.
You are evaluating the discharge teaching you have done with your patient concerning their drug therapy. What statement from the patient would indicate that teaching had been effective?
- A. I have to take three pills each day. It doesn't matter when.'
- B. I should take the white pill in the morning and the green pill in the afternoon. I don't know what they are called.'
- C. I need to tell all my other doctors that I am taking this Coumadin because it could interact with other drugs.'
- D. I think I could cut that pill in half if I wanted to.'
Correct Answer: C
Rationale: Understanding drug interactions with Coumadin (warfarin) shows effective teaching on safety and coordination of care.