Nokea
Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:
- A. Symptoms are severe
- B. Patient has not responded to other therapies
- C. Patient has concurrent hypertension
- D. Left ventricular dysfunction is diagnosed
Correct Answer: D
Rationale: Beta blockers are initiated upon diagnosis of left ventricular dysfunction to improve outcomes.
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A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100 . The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?
- A. Reduced cardiac function
- B. First pass effect
- C. Reduced hepatic function
- D. Increased gastric motility
Correct Answer: C
Rationale: Reduced hepatic function in older adults slows metabolism of hypnotics, prolonging drowsiness.
The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the students to affect absorption of the IM administration of drugs?
- A. Perfusion of blood to the subcutaneous tissue
- B. Integrity of the mucous membranes
- C. Environmental temperature
- D. Blood flow to the gastrointestinal tract
Correct Answer: C
Rationale: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.
symptomatic and metabolic improvement. Until that time, which of the following might be administered adjunctively to suppress glucocorticoid synthesis?
- A. Cimetidine
- B. Cortisol (massive doses)
- C. Fludrocortisone
- D. Ketoconazole
Correct Answer: D
Rationale: Ketoconazole inhibits glucocorticoid synthesis by blocking adrenal steroidogenesis, useful in Cushing's syndrome management.
While administering a medication that the nurse has researched and found to have limited effectiveness, the patient tells the nurse, I have read all about this drug and it is such a wonder drug. I'm so lucky my doctor prescribed it because I just know it will treat my problem. The nurse suspects this drug will be more effective than usual for this patient because of what effect?
- A. Cumulative effect
- B. First-pass effect
- C. Placebo effect
- D. Cross-tolerance effect
Correct Answer: C
Rationale: A drug is more likely to be effective if the patient thinks it will work than if the patient believes it will not work. This is called the placebo effect. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class.
Choose a drug that is used for both non-Hodgkin's lymphoma and rheumatoid arthritis:
- A. Doxorubicin
- B. Vincristine
- C. Infliximab
- D. Rituximab
Correct Answer: D
Rationale: Rituximab targets CD20 in lymphoma and is also used in rheumatoid arthritis.