Nokea
A woman who is pregnant develops gestational diabetes. The NP's initial action is to:
- A. prescribe an oral antidiabetic agent.
- B. give her information about diet and exercise.
- C. begin treating her with daily insulin injections.
- D. reassure her that her glucose levels will return to normal after pregnancy.
Correct Answer: B
Rationale: The correct answer is B because diet and exercise are the initial management for gestational diabetes. Choice A is incorrect (oral agents lack sufficient safety data). Choice C is wrong (insulin isn’t first-line). Choice D is inaccurate (reassurance alone doesn’t address current needs).
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Reasons for restricted distribution of drugs include:
- A. High cost
- B. Serious safety concerns
- C. Limited supply
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because restricted distribution (e.g., REMS) is primarily for drugs with serious safety risks (e.g., thalidomide), not cost or supply alone. Choice A is incorrect as cost doesn't mandate restriction—insurance handles that. Choice C is wrong because limited supply isn't a REMS trigger. Choice D is incorrect since only B is the core reason.
VKORC1 genetic variations would affect which drug?
- A. Warfarin
- B. Codeine
- C. Acetaminophen
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because VKORC1 variants alter warfarin's target enzyme, affecting its anticoagulant effect and requiring dose adjustments. Choice B is incorrect as codeine's action is CYP2D6-mediated, not VKORC1-related. Choice C is wrong because acetaminophen doesn't interact with VKORC1—it's unrelated to coagulation. Choice D is incorrect since only warfarin is impacted by VKORC1 genetics.
Drugs that may cause anticholinergic effects include:
- A. Diphenhydramine
- B. Atenolol
- C. Lisinopril
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because diphenhydramine has strong anticholinergic effects (e.g., confusion, dry mouth), risky in the elderly, per Beers Criteria. Choice B is incorrect as atenolol (beta blocker) lacks anticholinergic action. Choice C is wrong because lisinopril (ACE inhibitor) doesn't affect cholinergic systems. Choice D is incorrect since only diphenhydramine applies.
A client is admitted with coronary artery disease (CAD) and reports dyspnea at rest. What is the nurse's priority intervention?
- A. Elevate the head of the bed.
- B. Administer oxygen.
- C. Perform continuous ECG monitoring.
- D. Apply a nasal cannula.
Correct Answer: A
Rationale: The nurse's priority intervention for a client with coronary artery disease (CAD) experiencing dyspnea at rest is to elevate the head of the bed. Elevating the head of the bed helps improve lung expansion and reduces the workload on the heart, aiding in respiratory effort and cardiac function. This intervention is crucial in enhancing oxygenation and optimizing cardiac output in individuals with CAD presenting with dyspnea. Administering oxygen (Choice B) is important but elevating the head of the bed takes precedence as it directly addresses the client's respiratory distress. Continuous ECG monitoring (Choice C) and applying a nasal cannula (Choice D) are relevant interventions but not the priority when a client with CAD reports dyspnea at rest.
A primary care NP is preparing to prescribe a fluoroquinolone for a patient who has a history of alcohol abuse that has caused liver damage. The NP should choose:
- A. norfloxacin.
- B. levofloxacin.
- C. gemifloxacin.
- D. ciprofloxacin.
Correct Answer: B
Rationale: The correct answer is B because levofloxacin has lower hepatic risk, safer for liver-damaged patients. Choices A, C, and D are incorrect (higher hepatic risk).