Nokea
Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
- A. Protein malnutrition
- B. Iron-deficiency anemia
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: A
Rationale: Choice A is correct because phase I metabolism, involving cytochrome P450 enzymes, relies on protein for enzyme synthesis; malnutrition impairs this, reducing metabolism. Choice B is incorrect as iron deficiency affects oxygen transport, not directly phase I processes. Choice C is wrong since only protein malnutrition, not iron deficiency, is directly relevant. Choice D is incorrect because protein malnutrition does impact metabolism.
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When determining drug treatment, the NP prescriber should:
- A. Always use evidence-based guidelines
- B. Individualize the drug choice for the specific patient
- C. Rely on his or her experience when prescribing for complex patients
- D. Use the newest drug on the market for the condition being treated
Correct Answer: B
Rationale: Choice B is correct because tailoring treatment to the patient's unique factors—age, comorbidities, preferences—optimizes efficacy and safety. Choice A is incorrect as guidelines inform but don't dictate every case. Choice C is wrong because experience alone may lack evidence support. Choice D is incorrect since newest drugs aren't always best—evidence and patient fit matter more.
Patient education for the elderly should include:
- A. Explanation of drug purpose
- B. Instructions for safe administration
- C. Potential side effects
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because explaining purpose (improves adherence), safe administration (prevents errors), and side effects (enhances safety) are all key for elderly education, per geriatric care. Choice A is incorrect alone as it's one aspect. Choice B is wrong by itself because administration is just part. Choice C is incorrect solo since side effects are only one element.
Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):
- A. A 32-year-old male
- B. A 22-year-old female
- C. A 3-month-old female
- D. A 48-year-old male
Correct Answer: C
Rationale: Choice C is correct because a 3-month-old female is at higher risk for ADRs due to immature liver and kidney function, reducing drug metabolism and excretion, increasing toxicity potential. Choice A is incorrect as a healthy 32-year-old male typically has mature systems. Choice B is wrong because a 22-year-old female also has developed metabolism. Choice D is incorrect since a 48-year-old male, unless compromised, has lower risk than an infant.
The healthcare provider assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic?
- A. Tall, spiked T waves
- B. A prolonged QT interval
- C. A widening QRS complex
- D. Presence of a U wave
Correct Answer: D
Rationale: The presence of a U wave is often associated with hypokalemia, a possible side effect of diuretic therapy like furosemide. Hypokalemia can lead to U wave formation on an electrocardiogram, making the presence of U waves a concerning finding in clients taking diuretics. Tall, spiked T waves are typically seen in hyperkalemia, not hypokalemia. A prolonged QT interval is more commonly associated with conditions like Long QT syndrome or certain medications, not specifically with diuretics. A widening QRS complex is usually seen in conditions affecting the conduction system of the heart, such as bundle branch blocks, rather than being directly related to diuretic use.
The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had chickenpox as a child. The NP should:
- A. obtain a varicella titer.
- B. administer the Varivax vaccine.
- C. give the patient the Zostavax vaccine.
- D. plan to prescribe Zovirax if the patient is exposed to shingles.
Correct Answer: C
Rationale: The correct answer is C because Zostavax is recommended for adults over 60 to prevent shingles, regardless of prior chickenpox. Choice A is incorrect (titer not needed). Choice B is wrong (Varivax not for shingles). Choice D is inaccurate (prophylaxis not standard).