Nokea
A patient on a Class IV antiarrhythmic is experiencing bradycardia. Which medication is the patient most likely taking?
- A. Amiodarone
- B. Diltiazem
- C. Flecainide
- D. Lidocaine
Correct Answer: B
Rationale: Diltiazem, a Class IV calcium channel blocker, slows AV node conduction, commonly causing bradycardia.
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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.
Mary has a two-tiered prescription benefit plan, which means:
- A. She can receive differing levels of care based on whether she chooses an 'in-plan' provider or not.
- B. She is eligible for the new Medicare Part D 'donut hole' reduction of costs program.
- C. She pays a higher copay for brand-name drugs than for generic drugs.
- D. She must always choose to be treated with generic drugs first.
Correct Answer: C
Rationale: A two-tiered plan typically involves higher copays for brand-name drugs.
Who defines the standards of care for the practice of nursing? (Select one that does not apply.)
- A. State boards of nursing
- B. Hospital policy and procedures
- C. Federal laws regulating health care facilities
- D. The Joint Commission
Correct Answer: B
Rationale: Standards of care are defined by state boards of nursing, federal laws regulating health care facilities, The Joint Commission, and professional nursing associations such as the American Nurses Association. Individual hospital policies and procedures incorporate federal and state guidelines into their respective policies and procedures and are often more stringent than state and federal regulations.
A nurse is caring for an older adult client in a long-term care facility who has Hypothyroidism and a new prescription for Levothyroxine. Which of the following dosage schedules should the nurse expect for this client?
- A. The client will remain 0.1 mg dose, and the dose will be 0.1 mg of 0.1 mg dose, and the dose will be... (truncated)
Correct Answer: A
Rationale: Older adults typically start with a low dose (e.g., 0.025-0.05 mg) of levothyroxine, titrated slowly; 0.1 mg is plausible with adjustment.
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.