Nokea
Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
- A. High-dose colchicine
- B. Low-dose colchicine
- C. High-dose aspirin
- D. Acetaminophen with codeine
Correct Answer: B
Rationale: Low-dose colchicine effectively treats acute gout with fewer side effects than high-dose ; aspirin worsens gout.
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First dose phenomenon is a characteristic side effect on initiation of antihypertensive therapy with
- A. Minoxidil
- B. Clonidine
- C. Metroprolol
- D. Prazosin
Correct Answer: B
Rationale: Clonidine can cause sedation or hypotension after the first dose.
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
- A. Ensure the patient will not have increased adverse effects from the tamoxifen
- B. Identify if the patient is a poor metabolizer, potentially reducing conversion to active metabolites
- C. Evaluate risk of drug interactions with tamoxifen
- D. Determine if the patient requires a higher dose due to ultra-rapid metabolism
Correct Answer: B
Rationale: CYP2D6 testing identifies poor metabolizers who may not convert tamoxifen to its active form (endoxifen), impacting efficacy, not just ADRs or interactions .
NSAIDs should be avoided in which group(s) of patients?
- A. Kidney disease
- B. Myocardial infarction
- C. Irritable bowel syndrome
- D. All of the above
Correct Answer: D
Rationale: NSAIDs can worsen kidney function, increase cardiovascular risk, and exacerbate GI conditions, making them risky for all listed groups.
The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally. Which is true regarding the substitution of this medication to suppository form?
- A. It is standard practice when the patient is unable to take the ordered medication.
- B. It is acceptable if the patient agrees to the altered route form.
- C. It is preferable to having the patient miss a dose of the medication.
- D. It is contraindicated without an order from the health care provider.
Correct Answer: D
Rationale: One dosage form of medication should never be substituted for another unless the prescriber is consulted; there can be a great variation in the absorption rate of the medication through different routes of administration. The substitution of one form for another is not standard practice, and is not acceptable or preferable without the prescriber's order.
The nurse is caring for a patient who had a severe, acute, previously unseen adverse effect of a drug in Phase III testing. The patient asks, After all the testing done on this drug, didn't they know this adverse effect could occur? What is the nurse's best response? (Select one that does not apply.)
- A. Pharmaceutical companies sometimes underreport problems to make more money.
- B. Your response to this medication will be reported to the drug company and the Food and Drug Administration (FDA).
- C. After a drug reaches phase III testing it is considered an accepted drug and will not be recalled.
- D. The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects.
Correct Answer: B
Rationale: When a new and unexpected adverse effect occurs, especially one of a serious nature, it is reported to the drug company who reports it to the FDA immediately. When a large number of people begin using the drug in phase III studies, it is not unusual to identify adverse effects not previously noted. It would be both unprofessional and inaccurate to imply that pharmaceutical companies put profit ahead of patient concern because lawsuits would remove any potential profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in deciding whether to allow the drug to move to the next phase of testing. Drugs found to have serious adverse effects can be removed from the market at any time.