Nokea
No physical dependence is seen in:
- A. Dextropropoxyphene
- B. Fortwin
- C. Fluoxetine
- D. Alprax
Correct Answer: C
Rationale: Fluoxetine (SSRI) has no physical dependence; others do.
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A nurse is providing teaching to a client who has a new prescription for Amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching?
- A. Expect therapeutic effects in 24 to 48 hr.
- B. Discontinue the medication after a week of improved mood.
- C. Change positions slowly to minimize dizziness.
- D. Decrease injury from the first dose.
Correct Answer: C
Rationale: Slow position changes prevent dizziness, and chewing gum relieves dry mouth, common with tricyclics like amitriptyline.
Drug levels should be monitored in the treatment of
- A. Diabetes
- B. Epilepsy
- C. Status Asthmatics
- D. Hypertension
Correct Answer: B
Rationale: Therapeutic drug monitoring is critical in epilepsy (e.g., phenytoin) due to narrow therapeutic ranges.
A patient has been using sleeping pills every night for the past several months. Now admitted to the hospital, he is prescribed his usual dose of sleeping pill. After administration, the patient continues to be restless and is wide awake. The nurse notifies the health care provider, who prescribes an increased dose. After receiving the new dose, the patient falls asleep. The nurse interprets this as which of the following?
- A. Drug idiosyncrasy
- B. Cumulative drug effect
- C. Drug tolerance
- D. Toxic reactions
Correct Answer: C
Rationale: The patient has developed drug tolerance and has to be administered an increased dosage of the drug to achieve the desired effect. Cumulative drug effect occurs when the body is unable to metabolize and excrete one (normal) dose of a drug before the next dose is given. Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. Toxic reactions are caused when blood concentration levels exceed the therapeutic levels of a drug.
The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?
- A. Pancreatitis
- B. Diabetes mellitus
- C. Myocardial infarction
- D. Chronic obstructive pulmonary disease
Correct Answer: A
Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.
What is the most likely mechanism for hip fracture in patients with glucocorticoid longterm treatment?
- A. Increased intestinal calcium absorption
- B. Increased sex hormone synthesis
- C. Inhibition of bone formation
- D. Osteoarthritis
Correct Answer: C
Rationale: Glucocorticoids inhibit bone formation by suppressing osteoblast activity, increasing osteoporosis and fracture risk.