An example of a first-dose reaction that may occur includes:
- A. Orthostatic hypotension that does not occur with repeated doses
- B. Purple glove syndrome with phenytoin use
- C. Hemolytic anemia from ceftriaxone use
- D. Contact dermatitis from neomycin use
Correct Answer: A
Rationale: Choice A is correct because orthostatic hypotension can occur with a first dose of drugs like antihypertensives, subsiding as the body adjusts, a classic first-dose reaction. Choice B is incorrect as purple glove syndrome is a rare phenytoin effect, not first-dose specific. Choice C is wrong because hemolytic anemia is a type II reaction, not first-dose. Choice D is incorrect since contact dermatitis is a delayed, not first-dose, reaction.
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An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the NP recommend for this patient?
- A. Loratadine (Claritin)
- B. Hydroxyzine (Vistaril)
- C. Diphenhydramine (Benadryl)
- D. Chlorpheniramine maleate (Chlorphen 12)
Correct Answer: A
Rationale: The correct answer is A because loratadine is a nonsedating antihistamine, safer for elderly per Beers criteria, unlike the sedating options B, C, and D, which increase fall risk and cognitive impairment in older adults.
Drugs that may cause sedation in the elderly include:
- A. Benzodiazepines
- B. Antihistamines
- C. Opioids
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because benzodiazepines (e.g., lorazepam), antihistamines (e.g., diphenhydramine), and opioids (e.g., oxycodone) all cause sedation, increasing fall risk in the elderly, per Beers Criteria. Choice A is incorrect alone as it's one class. Choice B is wrong by itself because antihistamines are just part. Choice C is incorrect solo since opioids are only one group.
Drugs that may increase risk of erectile dysfunction include:
- A. Testosterone
- B. Beta blockers
- C. Alpha blockers
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because beta blockers (e.g., propranolol) can cause erectile dysfunction by reducing blood flow, a known side effect. Choice A is incorrect as testosterone improves erectile function. Choice C is wrong because alpha blockers often treat ED causes. Choice D is incorrect since only beta blockers fit.
Resources for patients with drug abuse issues include:
- A. Substance Abuse and Mental Health Services Administration (SAMHSA)
- B. National Institute on Drug Abuse (NIDA)
- C. Local support groups
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because SAMHSA (helpline), NIDA (research/support), and local groups (e.g., AA) provide comprehensive resources for drug abuse, per national frameworks. Choice A is incorrect alone as it's one resource. Choice B is wrong by itself because NIDA is just part. Choice C is incorrect solo since groups are only one option.
A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient's psychiatrist and will recommend that she:
- A. stop taking the sertraline now.
- B. continue taking the antidepressant.
- C. change to a different antidepressant.
- D. taper off the sertraline gradually.
Correct Answer: B
Rationale: The correct answer is B because continuing sertraline is often safer than untreated depression, with psychiatric consultation. Choice A is incorrect (abrupt stopping risky). Choice C is wrong (changing not first step). Choice D is inaccurate (tapering not indicated without specialist input).