Nokea
An injection of penicillin into a penicillin-sensitized person may lead to death due to:
- A. absence of histamine
- B. a Shwartzman's reaction
- C. release of enzymes from polymorphonuclear leukocytes
- D. constriction of bronchioli and drop in blood pressure
Correct Answer: B
Rationale: A Shwartzman's reaction is a severe inflammatory response that occurs when a person who has previously been sensitized to penicillin is re-exposed to the drug. This exaggerated response can lead to widespread activation of inflammatory mediators and is characterized by endotoxin-induced intravascular coagulation. This can result in a cascade of events leading to tissue damage, organ failure, and potentially death. It is different from a typical allergic reaction mediated by histamine release or constriction of bronchioli and drop in blood pressure. Additionally, the release of enzymes from polymorphonuclear leukocytes is not directly related to the fatal outcome of a penicillin injection in a sensitized individual.
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A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?
- A. Vitamin E
- B. Vitamin K
- C. Protamine sulfate
- D. Potassium chloride
Correct Answer: B
Rationale: Vitamin K is the antidote for warfarin (Coumadin) toxicity. Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent coagulation factors (II, VII, IX, X) in the liver. In cases of excessive anticoagulation and bleeding, administering vitamin K can help reverse the effects of warfarin by replenishing the depleted vitamin K-dependent clotting factors. Vitamin K helps the liver produce clotting factors, thereby promoting the clotting process and reversing the excessive anticoagulant effects of warfarin. Other options mentioned, such as Vitamin E, Protamine sulfate, and Potassium chloride, are not appropriate antidotes for warfarin toxicity.
For the patient taking acetaminophen, what should the nurse do? (Select all that apply.)
- A. Monitor routine liver enzyme tests.
- B. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing.
- C. Report side effects immediately, as toxicity can cause severe hepatic damage.
- D. Teach the female patient that oral contraceptives can increase the effect of acetaminophen.
Correct Answer: D
Rationale: Acetaminophen is metabolized in the liver, and excessive doses can lead to hepatotoxicity. Routine monitoring of liver enzymes is essential to detect early signs of liver damage. Patients should also be educated to check the acetaminophen content in over-the-counter medications to avoid accidental overdose. Reporting side effects promptly is crucial, as acetaminophen toxicity can cause severe and potentially fatal liver damage. While oral contraceptives can affect drug metabolism, they do not significantly increase the effects of acetaminophen. Therefore, the correct actions are to monitor liver enzymes, educate about over-the-counter medications, and report side effects.
Which of the following medications would you administer for an overdose of acetaminophen?
- A. Naloxone
- B. Vitamin K
- C. Acetylcysteine
- D. Atropine
Correct Answer: C
Rationale: Acetylcysteine is the antidote for an acetaminophen overdose. Acetaminophen overdose can cause liver damage due to its toxic metabolite buildup in the liver. Acetylcysteine works by replenishing glutathione, which helps in detoxifying the toxic metabolite of acetaminophen. Administering acetylcysteine within 8-10 hours of the overdose is crucial in preventing severe liver damage and improving the patient's outcome. Naloxone is used for opioid overdose, Vitamin K for treating specific types of bleeding disorders, and Atropine for drug poisoning or certain types of poisoning, but they are not indicated for an acetaminophen overdose.
Which patient-teaching instructions are appropriate for a patient taking an antidysrhythmic drug? (Select all that apply.)
- A. Do not chew or crush extende
- B. release forms of medication.
- C. Take the medication with food if gastrointestinal distress occurs.
- D. If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken.
Correct Answer: A
Rationale: A. Do not chew or crush extended-release forms of medication. This is an appropriate instruction because chewing or crushing extended-release forms of medication can alter their intended time-release action, leading to an overdose or underdose.
Barium enema is a drug used for :
- A. diagnosis;
- B. prevention;
- C. contraception;
- D. stimulation ;
Correct Answer: A
Rationale: Barium enema is a diagnostic imaging test used to examine the large intestine (colon and rectum). It involves the administration of a contrast material containing barium into the colon through the rectum, followed by X-rays to produce clear images of the colon's lining. This procedure helps in the diagnosis of various conditions such as colon polyps, diverticulosis, colorectal cancer, and inflammatory bowel disease. Therefore, barium enema is primarily used for diagnostic purposes, not for prevention, contraception, stimulation, or treatment of conditions.