A nurse is preparing to administer heparin 15,000 units subcutaneously every 12 hr. The amount available is heparin injection 20,000 units/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Do not use a trailing zero.)
- A. 0.8
- B. 1
- C. 0.2
- D. 0.5
Correct Answer: A
Rationale: Calculation: 15,000 units ÷ 20,000 units/mL = 0.75 mL, rounded to 0.8 mL, matching the answer.
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Jim presents with complaints of 'heartburn' that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:
- A. Omeprazole (Prilosec) twice a day
- B. Ranitidine (Zantac) twice a day
- C. Famotidine (Pepcid) once a day
- D. Metoclopramide (Reglan) four times a day
Correct Answer: B
Rationale: Ranitidine , an H2 blocker, is a standard first-line GERD treatment; PPIs are next-step, and metoclopramide is for motility.
The patient looks at the prescription provided by the doctor and asks the nurse whether he can request a generic substitution. The nurse answers No when noting what on the prescription?
- A. No refills
- B. DAW
- C. Brand name used on prescription
- D. Patient older than 65 years of age
Correct Answer: B
Rationale: DAW stands for dispense as written and means that the doctor does not want a generic substituted for the prescribed medication. Requesting no refills does not preclude the substitution of a generic medication. Even when the brand name is ordered, the pharmacist can substitute a generic equivalent so long as the prescriber does not write DAW. Generic substitutions are not impacted by the patient's age.
The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type:
- A. A
- B. B
- C. C
- D. D
Correct Answer: B
Rationale: Type B reactions are idiosyncratic, unpredictable responses to normal doses, unlike dose-related Type A or chronic Type C/D.
The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patient's system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours?
- A. 22 mcg
- B. 16.5 mcg
- C. 11 mcg
- D. 5.5 mcg
Correct Answer: C
Rationale: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.
A patient has a drug level of 50 units/mL and the drug's half-life is 1 hour. If concentrations above 25 units/mL are considered toxic and no more drug is given, how long will it take for the blood level to reach the nontoxic range?
- A. 30 minutes
- B. 1 hour
- C. 2 hours
- D. 3 hours
Correct Answer: C
Rationale: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2). After 2 hours, the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range.