Nokea
A patient will begin taking two drugs that are both protein-bound. The primary care NP should:
- A. prescribe increased doses of both drugs.
- B. monitor drug levels, actions, and side effects.
- C. teach the patient to increase intake of protein.
- D. stagger the doses of drugs to be given 1 hour apart.
Correct Answer: B
Rationale: The correct answer is B because protein-bound drugs compete for albumin, requiring monitoring to adjust dosing. Choice A is incorrect as increasing doses without monitoring is risky. Choice C is wrong since dietary protein doesn’t affect this. Choice D is inaccurate as staggering doesn’t resolve binding issues.
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Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
- A. After the second dose
- B. After four to five half-lives
- C. When the patient feels the full effect of the drug
- D. One hour after IV administration
Correct Answer: B
Rationale: Choice B is correct because steady state is reached after four to five half-lives, when absorption equals elimination, stabilizing drug levels for therapeutic monitoring. Choice A is incorrect as the second dose is too early for steady state. Choice C is wrong because patient perception doesn't define pharmacokinetics. Choice D is incorrect since IV timing varies and doesn't inherently match steady state.
Drugs that are commonly used off-label include:
- A. Gabapentin
- B. Amitriptyline
- C. Quetiapine
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because gabapentin (e.g., anxiety), amitriptyline (e.g., pain), and quetiapine (e.g., insomnia) are often used off-label, supported by evidence, per clinical practice. Choice A is incorrect alone as it's one drug. Choice B is wrong by itself because amitriptyline is just part. Choice C is incorrect solo since quetiapine is only one agent.
A client has a new prescription for nitroglycerin. Which of the following instructions should the nurse include in the discharge teaching?
- A. Store the medication in a cool, dark place.
- B. Take the medication at bedtime.
- C. Take the medication on an empty stomach.
- D. Take the medication at the first sign of chest pain.
Correct Answer: D
Rationale: The correct instruction to include in the discharge teaching for a client with a new prescription for nitroglycerin is to take the medication at the first sign of chest pain. Nitroglycerin is a vasodilator that helps relax blood vessels, increasing blood flow to the heart muscle and reducing the workload of the heart. Taking it at the onset of chest pain helps alleviate angina symptoms quickly and effectively. Storing the medication in a cool, dark place (Choice A) is not a critical instruction for this medication. Taking the medication at bedtime (Choice B) or on an empty stomach (Choice C) is not relevant to the administration of nitroglycerin for angina relief.
The U.S. Food and Drug Administration ensures that generic drugs:
- A. Have the same active ingredient as the brand-name drug
- B. Are less expensive than the brand-name drug
- C. Have the same color as the brand-name drug
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because the FDA requires generics to have the same active ingredient, strength, and efficacy as brand-name drugs, ensuring therapeutic equivalence. Choice B is incorrect as cost isn't FDA-regulated—it's market-driven. Choice C is wrong because color can vary. Choice D is incorrect since only A is FDA-enforced.
Herbal products that should be avoided when a patient is taking warfarin include:
- A. Ginkgo biloba
- B. Echinacea
- C. Valerian root
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because ginkgo biloba has antiplatelet effects, enhancing warfarin's anticoagulation and bleeding risk, so it should be avoided. Choice B is incorrect as echinacea doesn't significantly interact with warfarin. Choice C is wrong because valerian root's sedative effects don't notably affect anticoagulation. Choice D is incorrect since only ginkgo biloba poses a clear risk.