Nokea
Men may require higher doses of which drug class due to differences in body composition?
- A. Lipid-soluble drugs
- B. Water-soluble drugs
- C. Drugs that are highly protein bound
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because men's greater lean mass dilutes water-soluble drugs, often requiring higher doses for efficacy, unlike others. Choice A is incorrect as lipid-soluble drugs align with fat, lower in men. Choice C is wrong because protein binding isn't sex-specific here. Choice D is incorrect since only water-soluble drugs apply.
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A patient develops hepatotoxicity from chronic acetaminophen use. The primary care NP may recommend:
- A. milk thistle.
- B. chondroitin.
- C. coenzyme Q.
- D. glucosamine.
Correct Answer: A
Rationale: The correct answer is A because milk thistle protects the liver from hepatotoxins like acetaminophen. Choices B, C, and D are incorrect as they lack this hepatoprotective effect.
A client with a history of chronic heart failure is being discharged. Which instruction should the nurse include in the discharge teaching?
- A. Weigh yourself daily and report a weight gain of 2 pounds or more in a day.
- B. Restrict fluid intake to 2000 mL per day.
- C. Increase your salt intake to prevent electrolyte imbalance.
- D. Exercise vigorously at least three times a week.
Correct Answer: A
Rationale: The correct answer is to weigh yourself daily and report a weight gain of 2 pounds or more in a day. This instruction is crucial because daily weights help in early detection of fluid retention, a common complication in heart failure. Monitoring weight is essential for managing heart failure and preventing exacerbations. Choice B is incorrect because fluid restriction may be necessary in some cases of heart failure, but a general limit of 2000 mL per day is not appropriate without individual assessment. Choice C is incorrect as increasing salt intake can worsen fluid retention and exacerbate heart failure symptoms. Choice D is incorrect because while exercise is beneficial for heart health, vigorous exercise may not be suitable for all heart failure patients and should be tailored to their specific condition.
Drugs that use CYP 3A4 isoenzymes for metabolism may:
- A. Induce the metabolism of another drug
- B. Inhibit the metabolism of another drug
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: C
Rationale: Choice C is correct because CYP 3A4 drugs can induce (speed up) or inhibit (slow down) metabolism of other drugs sharing this pathway, affecting their levels and efficacy. Choice A is incorrect as it's only half the story—induction happens, but inhibition does too. Choice B is wrong because it misses induction potential. Choice D is incorrect since both effects are well-documented with CYP 3A4.
Michael calls the clinic to ask about taking fish oil supplements with his simvastatin prescription. The NP's response is:
- A. Avoid fish oil as it will increase your risk of bleeding.
- B. There are no known interactions; it is safe to take fish oil with simvastatin.
- C. Avoid fish oil as it will decrease the effectiveness of the simvastatin.
- D. Fish oil should only be taken with simvastatin if prescribed by your cardiologist.
Correct Answer: B
Rationale: Choice B is correct because fish oil (omega-3s) and simvastatin both lower triglycerides with no significant interactions; studies show they're safe together, enhancing lipid benefits. Choice A is incorrect as fish oil's bleeding risk is minimal and not amplified by simvastatin. Choice C is wrong because fish oil doesn't reduce simvastatin's efficacy—they're complementary. Choice D is incorrect since no prescription is needed for this safe combination.
The parent of a 3-year-old is concerned that the child's legs are not straight. The primary care NP notes marked bowing of the child's lower extremities. Radiologic studies show decreased ossification of the child's bones. The NP should:
- A. prescribe vitamin D supplements.
- B. recommend calcium supplements.
- C. counsel the parent to increase the child's milk intake.
- D. ensure that the parent is buying vitamin D-fortified milk.
Correct Answer: A
Rationale: The correct answer is A because vitamin D deficiency causes rickets, leading to bowing legs, corrected with supplements. Choice B is incorrect (calcium needs vitamin D). Choice C is wrong (milk alone insufficient). Choice D is inaccurate (fortified milk not enough).