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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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.
Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?
- A. Valproate is safe during all trimesters of pregnancy.
- B. She can get pregnant while taking valproate, but she should take adequate folic acid.
- C. Valproate is not safe at any time during pregnancy.
- D. Valproate is a known teratogen, but may be taken after the first trimester if necessary.
Correct Answer: D
Rationale: Valproate is teratogenic (e.g., neural tube defects) but may be used post-first trimester if essential.
A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
- A. Ask about alcohol consumption
- B. Reassure her that these are harmless side effects
- C. Tell her that this signals a worsening of her infection
- D. Tell her to go to the emergency department immediately
Correct Answer: A
Rationale: Metronidazole with alcohol causes a disulfiram-like reaction (symptoms listed); it's not infection worsening or harmless . Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol.
Which of the following produced by the pancreatic beta cells:
- A. Insulin
- B. Gastrin
- C. Somatostatin
- D. Glucagon
Correct Answer: A
Rationale: Insulin is secreted by pancreatic beta cells to lower blood glucose.
A nurse is teaching a client about the use of Fluticasone to treat Perennial Rhinitis. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should use the spray every 4 hours while I am awake.
- B. It can take as long as 3 weeks before the medication takes a maximum effect.
- C. This medication can also be used to treat motion sickness.
- D. I can use this medication when my nasal passages are blocked.
Correct Answer: B
Rationale: Fluticasone takes up to 3 weeks for full effect , a key point for managing expectations.
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