Nokea
If you inject a drug with a pH of 6.5 and pka of 8.1 into a tissue with a pH of 7.4, to what extent would you expect this drug to be ionized in the tissue?
- A. over 50%
- B. 50%
- C. under 50%
- D. 100%
Correct Answer: A
Rationale: The percentage of ionization of a weak acid or base can be estimated using the Henderson-Hasselbalch equation:
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Which of the following 'overdoses' is most commonly associated with respiratory alkalosis, but when more severe a metabolic acidosis?
- A. Methanol
- B. Lead
- C. Paracetamol
- D. Salicylate
Correct Answer: D
Rationale: Overdose toxicities differ in acid-base effects. Methanol causes metabolic acidosis via formic acid, not respiratory alkalosis. Lead poisoning leads to anemia or neurologic issues, rarely acid-base shifts. Paracetamol overdose induces lactic acidosis from liver failure, not respiratory changes initially. Salicylate (e.g., aspirin) overdose stimulates the respiratory center early, causing hyperventilation and respiratory alkalosis (low pCO2), but severe cases add metabolic acidosis (high anion gap) from uncoupled oxidative phosphorylation and lactic acid buildup. Codeine, an opioid, depresses respiration, causing acidosis, not alkalosis. Salicylate's dual pattern is distinctive, requiring urgent recognition—initial alkalosis shifts to acidosis as toxicity worsens, guiding bicarbonate or dialysis treatment.
Why is it important to monitor ins and outs with patients using ACE inhibitors?
- A. To assess for renal impairment
- B. You must make sure the patient is receiving adequate fluid intake
- C. To assess the patient for potential heart failure
- D. To assess for decreased blood pressure
Correct Answer: D
Rationale: It is important to monitor ins and outs with patients using ACE inhibitors to assess for decreased blood pressure. ACE inhibitors are known to lower blood pressure by dilating blood vessels, which can sometimes lead to hypotension (low blood pressure). Monitoring the patient's fluid intake and output helps healthcare providers evaluate the patient's blood pressure response to the medication and make necessary adjustments to prevent complications such as dizziness, falls, or fainting. Regular monitoring is crucial to ensure the patient's safety and optimize the effectiveness of ACE inhibitor therapy.
A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient™s BP. Which form of nitroglycerin is most appropriate?
- A. Sublingual spray
- B. Transdermal patch
- C. Oral capsule
- D. IV infusion
Correct Answer: D
Rationale: In the emergency management of a patient with extremely high blood pressure, intravenous (IV) administration of nitroglycerin is the most appropriate form of delivery. IV infusion provides rapid and precise control of blood pressure by allowing the medication to take effect quickly and be titrated to the desired blood pressure level. This route of administration is crucial in acute settings like the emergency department, where immediate blood pressure management is needed. Other forms of nitroglycerin, such as sublingual spray, transdermal patch, or oral capsule, may not provide the rapid onset of action required in this critical situation.
A patient asks how to apply transdermal nitroglycerin. What is the nurse™s best response?
- A. Always apply the transdermal patch over the area of your chest where your heart is.
- B. Keep the previous patch on for 1 full day so you always have two patches on at a tim
- C.
- D. Apply the patch to hairless areas of the body.
Correct Answer: D
Rationale: Transdermal nitroglycerin patches should be applied to clean, dry, hairless areas of the body to ensure proper absorption of the medication. Hair can interfere with the absorption of the medication through the skin. Commonly recommended areas for application include the chest, upper arm, or abdomen. It is important to rotate application sites to prevent skin irritation and to follow the specific instructions provided by the healthcare provider or pharmacist.
Morphine over dose is treated with_____
- A. Naloxone
- B. Vitamin K
- C. Time
- D. Grapefruit juice
Correct Answer: A
Rationale: Morphine overdose is a medical emergency that can result in respiratory depression and potentially lead to death. Naloxone is a medication used to counteract the effects of opioids like morphine by binding to the same receptors in the brain and reversing the respiratory depression. Naloxone works quickly to restore normal breathing and consciousness in individuals who have overdosed on morphine. It is a critical intervention used to prevent fatal outcomes of opioid overdose, including morphine. Other options like Vitamin K, time, and grapefruit juice are not effective treatments for morphine overdose.