Nokea
A patient with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency?
- A. Vitamin B12
- B. Vitamin C
- C. Folate
- D. Niacin
Correct Answer: A
Rationale: Vitamin B12 deficiency can lead to anemia, potentially causing a systolic murmur.
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A 57-year-old man was recently diagnosed with Type-2 diabetes mellitus and placed on a medication. He began having myalgias and feeling sick and later developed respiratory distress, so he went to the hospital. His pH was 7.2, and he had elevated blood lactate levels. Which drug is likely causing his problem?
- A. Acarbose
- B. Glyburide
- C. Metformin
- D. Pioglitazone
Correct Answer: C
Rationale: Metformin is associated with lactic acidosis, presenting with low pH and high lactate, especially in overdose or renal impairment.
A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?
- A. Acetaminophen
- B. Estradiol
- C. Donepezil
- D. Bethanechol
Correct Answer: D
Rationale: Bethanechol increases gastric acid, potentially causing gastritis or ulcers.
A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-fast bacilli test. The nurse will tell the patient that
- A. drug resistance has probably occurred
- B. it may be another month before this test is negative
- C. the provider will change the pyrazinamide to ethambutol
- D. there may be a need to remain in the first phase of therapy for several weeks
Correct Answer: B
Rationale: Sputum negativity may take 2-3 months; positivity doesn't confirm resistance or prompt drug change . The goal is for the patient's sputum test to be negative 2 to 3 months after the therapy.
Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?
- A. A 35-year-old woman with cervical cancer
- B. A 41-year-old man with kidney stones
- C. A 50-year-old man with cirrhosis of the liver
- D. A 62-year-old woman in acute renal failure
Correct Answer: C
Rationale: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.
A nurse is assessing a client who has taken Procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following adverse effects of this medication? (Select one that does not apply.)
- A. Joint swelling
- B. Widened QRS complex
- C. Narrowed QT interval
- D. Easy bruising
Correct Answer: C
Rationale: Procainamide can widen QRS , cause bruising from lupus-like syndrome, and joint swelling .