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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Signs that a drug may be counterfeit include:
- A. Unusual packaging
- B. Lower than expected cost
- C. Different taste or texture
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because unusual packaging (e.g., misspellings), suspiciously low cost (too good to be true), and odd taste/texture (formulation issues) are all counterfeit indicators, per FDA warnings. Choice A is incorrect alone as it's one sign. Choice B is wrong by itself because cost is just part. Choice C is incorrect solo since taste/texture is only one clue.
Drugs that are affected by genetic polymorphisms of TPMT include:
- A. Warfarin
- B. Azathioprine
- C. Acetaminophen
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because azathioprine's metabolism via TPMT (thiopurine methyltransferase) varies genetically, risking toxicity in poor metabolizers if not adjusted. Choice A is incorrect as warfarin uses CYP2C9 and VKORC1, not TPMT. Choice C is wrong because acetaminophen isn't metabolized by TPMT—it's glucuronidated. Choice D is incorrect since only azathioprine is TPMT-dependent.
When teaching a client who has a new prescription for metformin, which of the following instructions should the nurse include?
- A. Take the medication with food.
- B. Monitor for signs of hyperglycemia.
- C. Increase your fluid intake.
- D. Expect a metallic taste in your mouth.
Correct Answer: C
Rationale: The correct instruction for a client starting metformin is to increase fluid intake. This is crucial to prevent gastrointestinal discomfort, a common side effect of metformin. Adequate hydration helps reduce the risk of gastrointestinal upset and ensures the medication is well-tolerated. Option A is generally true for metformin but is not as essential as maintaining proper hydration. Option B is important but not directly related to starting metformin. Option D is incorrect as a metallic taste in the mouth is not typically associated with metformin.
A healthcare professional is assessing a client who has a new prescription for levothyroxine. Which of the following findings should the healthcare professional report to the provider?
- A. Weight gain
- B. Increased heart rate
- C. Heat intolerance
- D. Elevated blood pressure
Correct Answer: C
Rationale: The correct answer is C: Heat intolerance. Heat intolerance is a concerning sign of levothyroxine toxicity and should be reported to the provider promptly. Levothyroxine is a medication used to treat hypothyroidism by supplementing the body's thyroid hormones. When a client experiences heat intolerance, it can indicate that the dose of levothyroxine is too high, leading to hyperthyroidism symptoms. Weight gain, increased heart rate, and elevated blood pressure are not typically associated with levothyroxine toxicity; instead, they are more commonly seen in conditions like hypothyroidism.
Strategies to improve adherence to medication regimes include:
- A. Assuming that the patient understands the directions on the prescription bottle
- B. Writing instructions at a sixth-grade reading level
- C. Including a family member in the patient's medication education
- D. Assuming that the patient's health literacy level is the same as their general literacy
Correct Answer: C
Rationale: Choice C is correct because involving a family member improves adherence by providing support and reinforcing education, especially for complex regimens. Choice A is incorrect as assuming understanding risks miscommunication. Choice B is wrong because sixth-grade level may not suit all patients—tailoring is better. Choice D is incorrect since health literacy often differs from general literacy, requiring specific assessment.