Nokea
An NP prescribes an oral elixir medication for a child who is to take 1 tsp PO bid. When counseling the child's parents about administering this drug, the NP should tell them to:
- A. shake the medication well before giving each dose.
- B. mix the medication with cereal or applesauce to improve its taste.
- C. administer the medication on an empty stomach to enhance absorption.
- D. use a syringe purchased at the pharmacy to measure the medication accurately.
Correct Answer: D
Rationale: The correct answer is D because a syringe ensures accurate dosing (teaspoons vary 2.5-7.8 mL). Choice A is incorrect (elixirs don’t need shaking). Choice B is wrong (mixing risks incomplete dosing). Choice C is inaccurate (empty stomach isn’t required).
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An adolescent girl reports having heavy menstrual periods. Her hemoglobin is consistently on the low end of the normal range. The primary care NP should prescribe:
- A. iron supplements.
- B. a folic acid supplement.
- C. oral contraceptive pills.
- D. increased red meats in her diet.
Correct Answer: C
Rationale: The correct answer is C because oral contraceptives reduce menstrual blood loss, preventing iron-deficiency anemia. Choice A is incorrect (iron for active anemia). Choice B is wrong (folic acid not preventive here). Choice D is inaccurate (diet insufficient).
Drugs that require patient monitoring under REMS include:
- A. Acetaminophen
- B. Clozapine
- C. Ibuprofen
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because clozapine requires monitoring (e.g., ANC for neutropenia) under its REMS program due to severe risks, unlike others. Choice A is incorrect as acetaminophen doesn't need REMS monitoring. Choice C is wrong because ibuprofen lacks such requirements. Choice D is incorrect since only clozapine applies.
Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
- A. After the second dose
- B. After four to five half-lives
- C. When the patient feels the full effect of the drug
- D. One hour after IV administration
Correct Answer: B
Rationale: Choice B is correct because steady state is reached after four to five half-lives, when absorption equals elimination, stabilizing drug levels for therapeutic monitoring. Choice A is incorrect as the second dose is too early for steady state. Choice C is wrong because patient perception doesn't define pharmacokinetics. Choice D is incorrect since IV timing varies and doesn't inherently match steady state.
Infants and young children are at higher risk of ADRs due to:
- A. Immature renal function in school-age children
- B. Lack of safety and efficacy studies in the pediatric population
- C. Children's skin being thicker than adults, requiring higher doses of topical medication
- D. Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution
Correct Answer: B
Rationale: Choice B is correct because limited pediatric studies mean less data on safety and efficacy, increasing ADR risk due to untested dosing and effects. Choice A is incorrect as immature renal function applies to infants, not school-age children specifically. Choice C is wrong because children's skin is thinner, not thicker, and this isn't the primary risk. Choice D is incorrect since infant muscle mass is lower, not higher, and not the key factor.
Off-label prescribing is:
- A. Regulated by the U.S. Food and Drug Administration
- B. Illegal by NPs in all states (provinces)
- C. Legal if there is scientific evidence for the use
- D. Regulated by the Drug Enforcement Administration
Correct Answer: C
Rationale: Choice C is correct because off-label prescribing—using a drug for an unapproved indication—is legal if supported by scientific evidence and clinical judgment, common in practice. Choice A is incorrect as the FDA doesn't regulate off-label use, just approval. Choice B is wrong because it's not illegal for NPs; it's allowed with justification. Choice D is incorrect since the DEA oversees controlled substances, not off-label prescribing.