Nokea
A doctor orders 250 mL of IV fluid to be infused over 1 hour using microdrip tubing (60 gtt/mL). What is the flow rate in drops per minute?
- A. 100 gtt/min
- B. 120 gtt/min
- C. 150 gtt/min
- D. 250 gtt/min
Correct Answer: D
Rationale: Flow rate = (250 mL 60 gtt/mL) ÷ (1 60) = 15,000 ÷ 60 = 250 gtt/min, matching microdrip where mL/hr = gtt/min.
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Activation of central alpha2 receptors results in inhibition of cardio acceleration and centers in the brain.
- A. Vasodilation
- B. Vasoconstriction
- C. Cardiovascular
- D. Respiratory
Correct Answer: B
Rationale: Alpha2 receptor activation (e.g., by clonidine) causes vasoconstriction and reduced sympathetic outflow.
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:
- A. It is a long-acting drug with potential for toxicity.
- B. Nitrate tolerance can develop.
- C. Orthostatic hypotension is a common adverse effect.
- D. It must be taken with milk or food.
Correct Answer: B
Rationale: A nitrate-free interval (e.g., after 2 p.m.) prevents tolerance.
Prescribers have been shown to override a medication alert about a patient's allergies when:
- A. The history showed that the patient had tolerated the medication in the past
- B. The benefit outweighed the risk
- C. The medication was therapeutically appropriate and needed
- D. All of the above
Correct Answer: D
Rationale: Prescribers may override alerts if past tolerance, benefit-risk balance, or therapeutic need justifies it.
A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what?
- A. The impact of the placebo effect on the patient's response.
- B. The accumulative effect of the drug if it has been taken for many years.
- C. The impact of the warmer environment on the patient's physical status.
- D. Problems with patient compliance with the drug regimen while on vacation.
Correct Answer: C
Rationale: Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue.
The adverse events of sulfonylurea drugs are:
- A. Hypoglycemia and weight gain
- B. Gastrointestinal symptoms
- C. Aggravation of heart failure
- D. Increased risk of bone fracture in females
Correct Answer: A
Rationale: Sulfonylureas like glyburide cause hypoglycemia and weight gain by increasing insulin release.