Nokea
Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
- A. Angina
- B. Coronary artery disease
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: C
Rationale: Patients with angina and CAD are at high risk for rebound effects like myocardial infarction.
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The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
- A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia
- B. The initial dose of glargine is 2 to 10 units per day
- C. Patients who have been on high doses of NPH will need tests for insulin antibodies
- D. Obese patients may require more than 100 units per day
Correct Answer: A
Rationale: Switching to glargine reduces the dose by 20% to prevent hypoglycemia due to its steady action vs. NPH peaks.
A nurse working in an emergency department is caring for a client who has Benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority?
- A. Administer flumazenil.
- B. Identify the client's level of orientation.
- C. Infuse IV fluids.
- D. Prepare the client for gastric lavage
Correct Answer: B
Rationale: Assessing orientation is the priority to determine the severity of toxicity and guide interventions.
What happens in the case of thyroid hormones triiodethyronine (T3) and tetraiodethyronine (T4) I the blood:
- A. Decrease thyrotropin hormone release in the blood
- B. Increase thyrotropin hormone release in the blood
- C. Decrease thyroid releasing hormone release in the blood
- D. Doesn't change thyrotropine and thyroid releasing hormone release
Correct Answer: A
Rationale: High T3 and T4 levels decrease TSH release via negative feedback on the pituitary.
A nurse is completing a nursing history for a client who takes Simvastatin. The nurse should identify which of the following disorders as a contraindication to adding Ezetimibe to the client's medications?
- A. History of severe constipation
- B. History of hypertension
- C. Active hepatitis C
- D. Type 2 diabetes mellitus
Correct Answer: C
Rationale: Active hepatitis C contraindicates ezetimibe due to increased liver risk with statins.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.