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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The nurse administers a specific medication to an older adult patient every 4 hours. The patient has a history of chronic renal failure. Why would this patient be at risk for toxic drug levels?
- A. Cumulative effect
- B. First-pass effect
- C. Drug interactions
- D. Cross-tolerance effect
Correct Answer: A
Rationale: If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Drug interactions occur when taken with other drugs, food, or complementary alternative therapies. Cross-tolerance is resistance to drugs within the same class.
An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?
- A. Tremors
- B. Dizziness
- C. Confusion
- D. Hallucinations
Correct Answer: C
Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.
Patients who are on long-term aspirin therapy should have ____ annually.
- A. Complete blood count
- B. Salicylate level
- C. Amylase
- D. Urine analysis
Correct Answer: A
Rationale: Annual CBC monitors for aspirin-related bleeding; salicylate isn't routine yearly.
The nurse uses what term to describe the drug level required to have a therapeutic effect?
- A. Critical concentration
- B. Dynamic equilibrium
- C. Selective toxicity
- D. Active transport
Correct Answer: A
Rationale: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Selective toxicity is the ability of a drug to attach only to those systems found in foreign cells. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney.
Angina pectoris, tachycardia, and arrhythmias are possible adverse effects of which of the following drugs?
- A. Clonidine
- B. Phenylephrine
- C. Propranolol
- D. Salbutamol
Correct Answer: D
Rationale: Salbutamol, a beta-2 agonist, can cause cardiac stimulation as a side effect.