Nokea
Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:
- A. Slurred speech and insomnia
- B. Bradycardia and confusion
- C. Dizziness and orthostatic hypotension
- D. Insomnia and decreased appetite
Correct Answer: D
Rationale: Insomnia and appetite suppression are common methylphenidate side effects.
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The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic to manage his surgical pain. The nurse explains that narcotic prescriptions must be written and cannot be called in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for? What is the nurses best response?
- A. The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug Administration (FDA) enforces their control.
- B. The increase in the number of drug addicts has made the rules stronger.
- C. The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances to reduce the risk of injury.
- D. Controlled substances like narcotics are controlled by the FDA and the DEA.
Correct Answer: D
Rationale: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of narcotics and other controlled substances.
Protein binding of a drug helps in
- A. Distribution
- B. Prolonging half life
- C. Limiting metabolism
- D. All of the above
Correct Answer: D
Rationale: Protein binding affects distribution (bound drugs stay in plasma), prolongs half-life (less free drug available for clearance), and limits metabolism (bound drug is less accessible to enzymes).
Long-term monitoring of patients who are taking carbamazepine includes:
- A. Routine troponin levels to assess for cardiac damage
- B. Annual eye examinations to assess for cataract development
- C. Monthly pregnancy tests for all women of childbearing age
- D. Complete blood count every 3 to 4 months
Correct Answer: D
Rationale: CBC monitoring detects carbamazepine-induced blood dyscrasias.
When administering an intradermal injection, the nurse would use a 1-mL syringe with which gauge of needle? Select one that does not apply.
- A. 26 gauge
- B. 27 gauge
- C. 29 gauge
- D. 25 gauge
Correct Answer: C
Rationale: A 1-mL syringe with a 25- to 27-gauge needle that is 1/4 to 5/8 inches long is best suited for intradermal injections.
Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:
- A. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with HLA-B*1502 allele
- B. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele
- C. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele
- D. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine
Correct Answer: C
Rationale: HLA-B*1502 in Asians increases Stevens-Johnson syndrome risk with carbamazepine , per FDA warning, not efficacy or interactions .