Nokea
A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching?
- A. Contact provider if heart rate is less than 60/min.
- B. Check pulse rate for 30 seconds and multiply result by 2.
- C. Increase intake of sodium.
- D. Take with food if nausea occur
Correct Answer: A
Rationale: Bradycardia (<60/min, A) is a sign of digoxin toxicity to report; pulse should be checked for 1 minute.
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The nurse is reviewing the patient's admission medication orders. What order would the nurse to question?
- A. Digoxin .5 mg orally now give one dose only
- B. Lasix 20 mg. IV every 4 hours times 3
- C. Gentamicin 80 mg IV to infuse over 1 hour every 12 hours
- D. Acetaminophen 650 mg PO every 4 hours as needed for pain
Correct Answer: A
Rationale: Digoxin .5 mg (0.5 mg) is a high initial dose; typical is 0.125-0.25 mg, requiring clarification.
The hypoglycemic mechanism of action of pioglitazone and rosiglitazon is:
- A. They are peroxisome proliferator activating receptor gamma (PPAR-Y) ligands and enhance absorption of glucose and fatty acid
- B. Enhance closure of ATP sensitive K+ channels and entrance of calcium in intracellular efflux via Ca2+ channels
- C. Decrease gluconeogenesis in the liver
- D. Increase tyrosine kinase activity
Correct Answer: A
Rationale: Pioglitazone and rosiglitazone activate PPAR-gamma, improving insulin sensitivity and glucose uptake in tissues.
Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?
- A. Paget's disease
- B. Pulmonary cancers
- C. Gallbladder surgery
- D. Some bariatric surgeries
Correct Answer: D
Rationale: Bariatric surgeries like gastric bypass can impair pancreatic function, necessitating enzymes; gallbladder doesn't typically.
Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?
- A. Vasodilation and decreased heart rate
- B. Increased secretion of gastric acid and motility of the GI smooth muscle
- C. Release of dopamine at the pleasure center
- D. Stimulation of the locus coeruleus
Correct Answer: A
Rationale: Nicotine causes vasoconstriction and increased heart rate, not vasodilation.
Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
- A. Increased risk of priapism
- B. Profound hypotension
- C. Development of blue discoloration to the visual field
- D. Inactivation of the ED medication effect
Correct Answer: B
Rationale: ED drugs (PDE5 inhibitors) with nitrates cause severe vasodilation, leading to hypotension.