Nokea
A nurse manager is reviewing the facility's policies for IV therapy with the members of his team. The nurse manager should remind the team that which of the following techniques helps minimize the risk of catheter embolism?
- A. Performing hand hygiene before and after IV insertion
- B. Rotating IV sites at least every 72 hr
- C. Minimizing tourniquet time
- D. Avoiding reinserting the needle into an IV catheter
Correct Answer: D
Rationale: Avoiding needle reinsertion prevents shearing of the catheter, reducing embolism risk.
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A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
- A. Prednisone
- B. Phenelzine (Nardil)
- C. Atenolol (Tenormin)
- D. Allopurinol (Zyloprim)
Correct Answer: A
Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.
The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein-binding sites, what would this do?
- A. Make the patient gentamicin deficient
- B. Make the patient fluconazole deficient
- C. Counteract any positive benefit the drugs would have
- D. Alter the effectiveness of both drugs
Correct Answer: D
Rationale: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other.
Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
- A. Fluoxetine (Prozac)
- B. Paroxetine (Paxil)
- C. Amitriptyline (Elavil)
- D. Duloxetine (Cymbalta)
Correct Answer: D
Rationale: Duloxetine addresses both depression and fatigue, unlike sedating options.
Etidronate is prescribed for a postmenopausal woman who is at great risk for developing osteoporosis. Which of the following adverse effects to this drug is the patient most likely to experience?
- A. Tetany
- B. Cholelithiasis
- C. Esophagitis
- D. Renal damage from calcium stone formation
Correct Answer: C
Rationale: Bisphosphonates like etidronate commonly cause esophagitis if not taken properly.
A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this is due to:
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.