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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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.
Food or drink that should be avoided when taking a prescription for simvastatin includes:
- A. Milk
- B. Orange juice
- C. Grapefruit juice
- D. Green leafy vegetables
Correct Answer: C
Rationale: Choice C is correct because grapefruit juice inhibits CYP3A4, which metabolizes simvastatin, increasing drug levels and rhabdomyolysis risk, so it's to be avoided. Choice A is incorrect as milk doesn't affect simvastatin significantly. Choice B is wrong because orange juice has no notable interaction. Choice D is incorrect since green leafy vegetables don't impact simvastatin metabolism.
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).
VKORC1 genetic variations would affect which drug?
- A. Warfarin
- B. Codeine
- C. Acetaminophen
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because VKORC1 variants alter warfarin's target enzyme, affecting its anticoagulant effect and requiring dose adjustments. Choice B is incorrect as codeine's action is CYP2D6-mediated, not VKORC1-related. Choice C is wrong because acetaminophen doesn't interact with VKORC1—it's unrelated to coagulation. Choice D is incorrect since only warfarin is impacted by VKORC1 genetics.
Risks to the fetus in the second trimester include:
- A. Exposure to teratogens causing abnormal organ development
- B. Maternal use of tobacco causing intrauterine growth restriction
- C. Maternal hypertension causing placental insufficiency
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because the second trimester involves growth, and tobacco restricts it via vasoconstriction, a key risk then. Choice A is incorrect as teratogens primarily affect organ development in the first trimester. Choice C is wrong because hypertension's placental effects are more third-trimester prominent. Choice D is incorrect since B is the specific second-trimester concern.