Nokea
An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior. The patient reports no change in symptoms, and a laboratory test reveals a subtherapeutic serum drug level. The NP caring for this patient should:
- A. consider ordering more frequent dosing of the drug.
- B. titrate the patient's dose upward and recheck in 1 month.
- C. ask the patient about any increased frequency of bowel movements.
- D. determine the number of pills left in the patient's prescription bottle.
Correct Answer: D
Rationale: The correct answer is D because elderly patients often have adherence issues due to cost or confusion, so checking pill count assesses compliance before adjusting dose. Choice A is incorrect as frequency isn’t the first step. Choice B is wrong since dose increase without compliance check is premature. Choice C is inaccurate as bowel changes aren’t the primary concern.
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The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's:
- A. Propensity to go to the target receptor
- B. Biological half-life
- C. Pharmacodynamics
- D. Safety and side effects
Correct Answer: B
Rationale: Choice B is correct because dosing cephalexin every 8 hours aligns with its biological half-life, the time it takes for half the drug to be eliminated, ensuring steady therapeutic levels. Choice A is incorrect as ‘propensity to target receptor' isn't a standard pharmacokinetic term for dosing decisions. Choice C is wrong because pharmacodynamics (drug effects) informs efficacy, not timing. Choice D is incorrect since safety and side effects influence drug choice, not specifically the 8-hour interval.
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value should the nurse monitor to assess the effectiveness of the medication?
- A. Activated partial thromboplastin time (aPTT)
- B. Prothrombin time (PT) and international normalized ratio (INR)
- C. Platelet count
- D. Erythrocyte sedimentation rate (ESR)
Correct Answer: B
Rationale: Prothrombin time (PT) and international normalized ratio (INR) are the laboratory values used to monitor the effectiveness of warfarin therapy. These values help ensure that the client is within the therapeutic range for anticoagulation. PT measures the time it takes for blood to clot, while INR standardizes PT results to minimize variations between laboratories. Monitoring these values is crucial to prevent complications such as bleeding or clot formation. Activated partial thromboplastin time (aPTT) (Choice A) is more commonly used to monitor heparin therapy. Platelet count (Choice C) assesses the number of platelets in the blood and is not specific to warfarin therapy. Erythrocyte sedimentation rate (ESR) (Choice D) is a non-specific marker of inflammation and is not used to monitor the effectiveness of warfarin therapy.
Differences between brand-name drugs and their generic equivalents include:
- A. Active ingredient
- B. Cost
- C. Color of the tablet
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because generics have the same active ingredient as brand-name drugs but typically cost less, per FDA bioequivalence rules. Choice A is incorrect as active ingredients are identical. Choice C is wrong because color may differ but isn't a functional difference. Choice D is incorrect since only cost is a consistent distinction.
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.
The nurse is caring for a client with heart failure who is receiving digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse monitor for?
- A. Hypertension
- B. Bradycardia
- C. Hyperglycemia
- D. Insomnia
Correct Answer: B
Rationale: Corrected Rationale: Bradycardia is a common sign of digoxin toxicity. Digoxin can cause bradycardia due to its effects on the heart's electrical conduction system. Monitoring for a slow heart rate is crucial as it indicates potential toxicity. Hypertension, hyperglycemia, and insomnia are not typically associated with digoxin toxicity. Hypertension is more commonly seen in other conditions, hyperglycemia is not a typical sign of digoxin toxicity, and insomnia is not a recognized symptom of digoxin toxicity.