Nokea
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.
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A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care NP that she is trying to get pregnant. The NP should:
- A. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
- B. lower her angiotensin converting enzyme inhibitor dose during the first trimester.
- C. counsel her to increase her antihypertensive medications during pregnancy.
- D. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy.
Correct Answer: A
Rationale: The correct answer is A because ACE inhibitors are contraindicated in pregnancy and should be replaced with safer options like methyldopa. Choice B is incorrect (lowering dose still risky). Choice C is wrong (increasing not indicated). Choice D is inaccurate (ARBs also contraindicated).
A client is taking levothyroxine for hypothyroidism. Which of the following findings should indicate to the healthcare provider that the client is experiencing levothyroxine toxicity?
- A. Weight loss
- B. Insomnia
- C. Heat intolerance
- D. Dry skin
Correct Answer: C
Rationale: Heat intolerance is a hallmark sign of levothyroxine toxicity. It indicates that the client may be receiving an excessive dose of levothyroxine, leading to hyperthyroid symptoms. This can happen when the dosage is too high, causing the body to have an excess of thyroid hormone. Weight loss is a common symptom of hyperthyroidism but alone does not specifically indicate levothyroxine toxicity. Insomnia can be related to hyperthyroidism but is not a specific sign of levothyroxine toxicity. Dry skin is more commonly associated with hypothyroidism rather than levothyroxine toxicity.
A healthcare professional is assessing a client who has a new prescription for warfarin. Which of the following findings should the healthcare professional report to the provider?
- A. Weight gain
- B. Frequent urination
- C. Hypokalemia
- D. Bleeding gums
Correct Answer: D
Rationale: Bleeding gums are a sign of excessive anticoagulation with warfarin, indicating a potential risk of bleeding complications. It is crucial to report this finding promptly to the provider for further assessment and adjustment of the medication regimen to prevent serious bleeding events. Weight gain, frequent urination, and hypokalemia are not typically associated with warfarin use and are not immediate concerns that require urgent reporting to the provider.
Drugs that require therapeutic drug monitoring include:
- A. Lithium
- B. Acetaminophen
- C. Albuterol
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because lithium has a narrow therapeutic range, necessitating monitoring to maintain efficacy for bipolar disorder while avoiding toxicity, unlike the others. Choice B is incorrect as acetaminophen, used for pain, has a wider safety margin and doesn't require routine monitoring. Choice C is wrong because albuterol, a bronchodilator, acts locally with minimal systemic levels needing checks. Choice D is incorrect since only lithium among these requires therapeutic drug monitoring.
The primary care NP sees a 4-year-old child who has persistent asthma episodes for a well-child visit in October. The child recently completed a 7-day course of oral steroids. The NP plans to give the child flu vaccine and should:
- A. administer LAIV today.
- B. administer 0.5 mg TIV today.
- C. wait 4 weeks and administer LAIV.
- D. wait 4 weeks and administer 0.5 mg TIV.
Correct Answer: B
Rationale: The correct answer is B because LAIV is contraindicated in asthmatic children aged 2-4; TIV is safe post-steroids. Choice A is incorrect (LAIV excluded). Choice C is wrong (waiting unnecessary). Choice D is inaccurate (waiting not needed).