Nokea
James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:
- A. Order cognitive testing to determine the source of his confusion.
- B. Sit down with him and explain the whole Medicare Part D process.
- C. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him.
- D. Request his son come to the next appointment so you can explain the benefit to him.
Correct Answer: C
Rationale: Referring to a specialist ensures accurate explanation of Medicare Part D.
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During which phase of pharmacokinetics could a significant drug-drug interaction occur, resulting in one drug stimulating or blocking the metabolism of the other drug?
- A. Absorption
- B. Distribution
- C. Biotransformation
- D. Excretion
Correct Answer: C
Rationale: During biotransformation, a drug may be metabolized quicker if taken at the same time as another drug, and higher doses of the drug will be needed to achieve the desired effect. During absorption, one drug can prevent or accelerate absorption of the other drug. During distribution, one drug competes for the protein-binding site of another drug so the second drug cannot be transported to the reactive tissue. During excretion, one drug competes for excretion with the other drug, leading to accumulation and toxic effects of one of the drugs.
Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
- A. Serum glucose
- B. Stool culture
- C. Folate levels
- D. Vitamin B12
Correct Answer: A
Rationale: Corticosteroids raise glucose, requiring monitoring; stool or vitamins aren't routine.
Aminoglycosides lack activity against streptococci.
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: Aminoglycosides are effective against some streptococci (e.g., when combined with cell wall-active agents), though they are primarily used for gram-negative bacteria.
A nurse is assessing a patient on ceftriaxone. Which allergy should be of particular concern?
- A. Sulfa
- B. Penicillin
- C. Tetracycline
- D. Macrolide
Correct Answer: B
Rationale: Ceftriaxone, a cephalosporin, has a risk of cross-reactivity with penicillin allergies due to similar beta-lactam structures.
A nurse is assessing a male client who recently began taking Haloperidol. Which of the following findings is the highest priority to report to the provider?
- A. Shuffling gait
- B. Neck spasms
- C. Drowsiness
- D. Impotence
Correct Answer: B
Rationale: Neck spasms indicate dystonia, an acute extrapyramidal symptom requiring immediate attention.