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Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
- A. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case
- B. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness
- C. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission
- D. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times
Correct Answer: B
Rationale: Warfarin's delayed onset requires heparin overlap for immediate anticoagulation; this is standard, not an error or exception .
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In an acute attack of migraine, the drug of choice is
- A. Ergotamine tartrate
- B. Methysergide
- C. Propranolol
- D. Caffeine
Correct Answer: A
Rationale: Ergotamine tartrate is the drug of choice for acute migraine.
The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?
- A. Weight loss
- B. Relief of heartburn
- C. Reduction of steatorrhea
- D. Absence of abdominal pain
Correct Answer: C
Rationale: Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.
Which of the following would the nurse identify as a factor that alters drug response in children and infants? (Select one that does not apply.)
- A. Slower gastric emptying
- B. Greater surface area
- C. Less protein binding
- D. Decreased body water content
Correct Answer: D
Rationale: Children and infants are not small adults; therefore, they have altered pharmacokinetics. Factors that alter pharmacokinetics in children include slower gastric emptying, less cutaneous fat, greater surface area, increased body water content, less protein binding, and immature hepatic and renal function.
Monitoring a patient on a high-dose aspirin level includes:
- A. Salicylate level
- B. Complete blood count
- C. Urine pH
- D. All of the above
Correct Answer: D
Rationale: High-dose aspirin requires salicylate levels , CBC for bleeding, and urine pH for excretion monitoring.
When prescribing temazepam (Restoril) for insomnia, patient education includes:
- A. Take temazepam nightly approximately 15 minutes before bedtime.
- B. Temazepam should not be used more than three times a week for less than 3 months.
- C. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better.
- D. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam.
Correct Answer: B
Rationale: Temazepam is recommended short-term (e.g., ≤3 times/week) to avoid dependence.