Nokea
A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?
- A. Digoxin 0.25 mg PO daily
- B. Digoxin 1 mg PO now; then 0.25 mg PO daily
- C. Digoxin 0.5 mg IV push daily
- D. Digoxin 1 mg IV push now; then 0.25 mg IV daily
Correct Answer: D
Rationale: When a patient requires immediate treatment for atrial fibrillation with digoxin, the fastest way to achieve a therapeutic effect is through intravenous administration. Option D, Digoxin 1 mg IV push now; then 0.25 mg IV daily, is the most appropriate order in this scenario. Intravenous administration allows for rapid absorption and onset of action, making it the preferred route for urgent situations like atrial fibrillation. By giving an initial loading dose intravenously, followed by a lower maintenance dose IV daily or orally, the patient can quickly achieve therapeutic digoxin levels to help stabilize the heart rhythm. Option D provides the most rapid and effective way to manage new-onset atrial fibrillation with digoxin.
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Basis for pharmacotherapeutics
- A. Selective action of drugs with regard to diagnosis, preventive and treatment of disease
- B. Bioavailability of drugs
- C. Biologic half-life of drugs
- D. Renal clearance and elimination of drugs
Correct Answer: A
Rationale: The basis for pharmacotherapeutics lies in the selective action of drugs with regard to the diagnosis, prevention, and treatment of diseases. Pharmacotherapeutics involves the use of drugs to manage diseases and improve health outcomes. Drugs are carefully selected based on their mechanism of action, efficacy, safety profile, and suitability for a specific condition. The goal is to achieve optimal therapeutic effects while minimizing potential adverse effects. By understanding the selective action of drugs in targeting specific pathways or processes in the body, healthcare providers can customize treatment regimens to individual patients and achieve the best possible outcomes.
Barbiturates are contraindicated in a dental patient with: II. emphysema III. Undiagnosed severe pain III. hypertension IV. Acute intermittent porphyria
- A. I, III & IV
- B. I & IV only
- C. II & III only
- D. II only
Correct Answer: A
Rationale: Barbiturates are central nervous system depressants that can exacerbate conditions such as emphysema, hypertension, and acute intermittent porphyria.
What should you monitor when given a patient Clopidogrel?
- A. Signs of thrombotic thrombolytic purpura
- B. Bleeding during therapy
- C. CBC with differential and platelet count
- D. All the above
Correct Answer: D
Rationale: When monitoring a patient on Clopidogrel therapy, it is important to monitor for signs of thrombotic thrombolytic purpura (TTP), bleeding during therapy, and changes in blood counts. Clopidogrel is an antiplatelet medication that works by preventing platelets from sticking together and forming clots. Monitoring for signs of TTP is necessary as clopidogrel has been associated with an increased risk of TTP in some patients. Additionally, monitoring for bleeding is crucial as clopidogrel, like other antiplatelet medications, can increase the risk of bleeding complications. Monitoring a complete blood count (CBC) with differential and platelet count allows healthcare providers to assess the patient's blood cell levels and ensure that the medication is not causing any adverse effects on blood counts. Therefore, monitoring all of the above parameters is essential to ensure the safety and efficacy of clopidogrel therapy.
The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal <20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action?
- A. Administration of mannitol
- B. Withholding mannitol at this time, but taking other measures to reduce intracranial pressure
- C. Administration of sodium nitroprusside
- D. Taking no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.
Liquid preparation made by boiling vegetable substances with water
- A. decoction
- B. fluid extract C solution
- C. spirits
- D. syrup
Correct Answer: A
Rationale: A decoction is a liquid preparation made by boiling vegetable substances with water. This process helps extract the beneficial properties and compounds from the plant material into the liquid. Decoctions are commonly used in herbal medicine to prepare medicinal remedies by simmering roots, bark, or other plant parts in water for a period of time.