Nokea
Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
- A. Decreased therapeutic levels of quinidine
- B. Increased therapeutic levels of quinidine
- C. Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
- D. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
Correct Answer: D
Rationale: Quinidine inhibits P-glycoprotein, increasing levels of drugs like digoxin by reducing efflux, not affecting quinidine itself or lowering digoxin .
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Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for to be used for an episode of status epilepticus.
- A. IV phenobarbital
- B. Rectal diazepam (Diastat)
- C. IV phenytoin (Dilantin)
- D. Oral carbamazepine (Tegretol)
Correct Answer: B
Rationale: Rectal diazepam is a rescue medication for status epilepticus at home.
A nurse is caring for a child on the pediatric unit. A drug is ordered for the child, but there is no pediatric dose listed for the drug. To make sure that the right dose has been ordered, what will the nurse use to calculate the correct dose?
- A. Surface area
- B. Height
- C. Birth date
- D. Age at gestation
Correct Answer: A
Rationale: Surface area, calculated via nomograms using height and weight, is the most accurate method for pediatric dosing adjustments.
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:
- A. Become a vegetarian because this disorder is associated with eating red meat.
- B. Stop taking the drug if abdominal cramps and diarrhea develop.
- C. Report muscle weakness or tenderness and dark urine to his provider immediately.
- D. Expect 'hot flash' sensations during the first 2 weeks of therapy.
Correct Answer: C
Rationale: Muscle symptoms and dark urine indicate rhabdomyolysis, requiring immediate reporting.
A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
- A. Ask about alcohol consumption
- B. Reassure her that these are harmless side effects
- C. Tell her that this signals a worsening of her infection
- D. Tell her to go to the emergency department immediately
Correct Answer: A
Rationale: Metronidazole with alcohol causes a disulfiram-like reaction (symptoms listed); it's not infection worsening or harmless . Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.