Nokea
Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
- A. White blood cell counts with the drug dosage increased for elevations above 10,000 feet
- B. Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal
- C. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
- D. Serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL
Correct Answer: C
Rationale: Elevated creatinine (>2.5 mg/dL) indicates renal impairment, requiring dose adjustment.
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Patient education regarding taking iron replacements includes:
- A. Doubling the dose if they miss a dose to maintain therapeutic levels
- B. Taking the iron with milk or crackers if it upsets their stomach
- C. Iron is best taken on an empty stomach with juice
- D. Antacids such as Tums may help the upset stomach caused by iron therapy
Correct Answer: C
Rationale: Iron absorption is best on an empty stomach with juice; milk or antacids reduce absorption, and doubling risks toxicity.
The bronchodilator of choice for patients taking propranolol is:
- A. Albuterol
- B. Pirbuterol
- C. Formoterol
- D. Ipratropium
Correct Answer: D
Rationale: Ipratropium , an anticholinergic, avoids beta-blockade interference from propranolol, unlike beta-agonists .
Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?
- A. Prochlorperazine (Compazine)
- B. Meclizine (Antivert)
- C. Promethazine (Phenergan)
- D. Ondansetron (Zofran)
Correct Answer: D
Rationale: Ondansetron is preferred in kids for nausea/vomiting, with fewer side effects than prochlorperazine or promethazine ; meclizine is for motion sickness.
Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:
- A. Contraceptive failure
- B. Excessive weight gain
- C. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
- D. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed
Correct Answer: C
Rationale: COCs induce lamotrigine metabolism, lowering its levels and requiring dose adjustment.
When moving to another state, what is the nurse responsible for becoming familiar with?
- A. Local policies and procedures for controlled substance administration
- B. Local provider's Drug Enforcement Agency (DEA) number for prescribing controlled substances
- C. The agency monitoring controlled substances in the new state
- D. Board of Nursing regulations of controlled substances in the new state
Correct Answer: A
Rationale: The nurse needs to learn local policies and procedures for controlled substance administration because they can vary with some local governments more rigorous than others. Nurses do not memorize a provider's DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. State boards of nursing do not regulate controlled substances but may regulate how controlled substances are administered by nurses.