Nokea
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:
- A. It is a long-acting drug with potential for toxicity.
- B. Nitrate tolerance can develop.
- C. Orthostatic hypotension is a common adverse effect.
- D. It must be taken with milk or food.
Correct Answer: B
Rationale: A nitrate-free interval (e.g., after 2 p.m.) prevents tolerance.
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Beta blockers are the drugs of choice for exertional angina because they:
- A. Improve myocardial oxygen supply by vasodilating the coronary arteries
- B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: B
Rationale: Beta blockers reduce oxygen demand by lowering heart rate and resistance, not by vasodilation.
Prescribers have been shown to override a medication alert about a patient's allergies when:
- A. The history showed that the patient had tolerated the medication in the past
- B. The benefit outweighed the risk
- C. The medication was therapeutically appropriate and needed
- D. All of the above
Correct Answer: D
Rationale: Prescribers may override alerts if past tolerance, benefit-risk balance, or therapeutic need justifies it.
Discharge planning for patients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comment by the patient would demonstrate a good understanding of OTC drugs?
- A. OTC drugs are safe and do not cause adverse effects if taken properly.
- B. OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA).
- C. OTC drugs are different from any drugs available by prescription and cost less.
- D. OTC drugs could cause serious harm if not taken according to directions.
Correct Answer: D
Rationale: It is important to follow package directions because OTCs are medications that can cause serious harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as directed; however, all drugs can produce adverse effects even when taken properly. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions.
Patients with iron deficiency will develop:
- A. Hemolytic anemia
- B. Megaloblastic anemia
- C. Macrocytic-hypochromic anemia
- D. Microcytic-hypochromic anemia
Correct Answer: D
Rationale: Iron deficiency causes microcytic-hypochromic anemia due to reduced hemoglobin synthesis.
Activation of central alpha2 receptors results in inhibition of cardio acceleration and centers in the brain.
- A. Vasodilation
- B. Vasoconstriction
- C. Cardiovascular
- D. Respiratory
Correct Answer: B
Rationale: Alpha2 receptor activation (e.g., by clonidine) causes vasoconstriction and reduced sympathetic outflow.