Nokea
Not metabolized in liver
- A. Cimetidine
- B. Phenytoin
- C. Diazepam
- D. Penicillin G
Correct Answer: D
Rationale: Penicillin G is primarily excreted unchanged by the kidneys, unlike the others metabolized by the liver.
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A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
- A. Prednisone
- B. Phenelzine (Nardil)
- C. Atenolol (Tenormin)
- D. Allopurinol (Zyloprim)
Correct Answer: A
Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.
A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this is due to:
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
Which of the following is used for treatment of hyperthyroidism:
- A. Liothironine
- B. Levothiroxine
- C. Propilthiouracil
- D. Liotrix
Correct Answer: C
Rationale: Propylthiouracil inhibits thyroid hormone synthesis, making it a standard treatment for hyperthyroidism.
Research has shown that when patients who are covered by Medicare Part D reach the 'donut hole' in coverage they:
- A. Ask for extra refills of medication to get them through the months of no coverage
- B. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin
- C. Fill their critical medications, but hold off on filling less-critical medications
- D. Demonstrate no change in their prescription filling pattern
Correct Answer: B
Rationale: Patients reduce prescription filling, even for critical drugs, during the donut hole.
When completing the check to ensure that the right drug is being administered to the client, which of the following should the nurse compare?
- A. Medication
- B. Container label
- C. Medication record
- D. All the above
Correct Answer: D
Rationale: The nurse compares the medication, container label, and medication record and then the MAR as the item is removed from the cart and before the actual administration of the drug.