Nokea
Reasons for restricted distribution of drugs include:
- A. High cost
- B. Serious safety concerns
- C. Limited supply
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because restricted distribution (e.g., REMS) is primarily for drugs with serious safety risks (e.g., thalidomide), not cost or supply alone. Choice A is incorrect as cost doesn't mandate restriction—insurance handles that. Choice C is wrong because limited supply isn't a REMS trigger. Choice D is incorrect since only B is the core reason.
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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.
When teaching a client with a new prescription for spironolactone, which instruction should the nurse include?
- A. Increase your intake of potassium-rich foods.
- B. Avoid consuming grapefruit juice.
- C. Take the medication with food.
- D. Monitor for signs of hyperkalemia.
Correct Answer: D
Rationale: The correct answer is to instruct the client to monitor for signs of hyperkalemia when taking spironolactone since it is a potassium-sparing diuretic. Hyperkalemia is a potential adverse effect due to the medication's mechanism of action. Advising the client to increase potassium-rich foods (Choice A) would be incorrect as it can further elevate potassium levels, which could lead to hyperkalemia. Avoiding grapefruit juice (Choice B) is not directly related to spironolactone use. Though taking the medication with food (Choice C) can help reduce gastrointestinal upset, it is not the most critical instruction when initiating spironolactone therapy.
To reduce medication errors, the Institute of Safe Medication Practices recommends:
- A. Using only brand names on prescriptions
- B. Avoiding the use of 'tall man' lettering
- C. Avoiding the use of error-prone abbreviations
- D. Using decimals instead of fractions when prescribing
Correct Answer: C
Rationale: Choice C is correct because the ISMP recommends avoiding error-prone abbreviations (e.g., ‘U' for units) to prevent misinterpretation and errors, a proven safety strategy. Choice A is incorrect as brand names alone don't reduce errors—generics are standard. Choice B is wrong because ‘tall man' lettering (e.g., LisinOPRIL) helps, not harms. Choice D is incorrect since decimals can confuse (e.g., .5 vs. 0.5)—whole numbers are safer.
Phase IV clinical trials in the United States are also known as:
- A. Human bioavailability trials
- B. Post marketing research
- C. Human safety and efficacy studies
- D. The last stage of animal trials before the human trials begin
Correct Answer: B
Rationale: Choice B is correct because phase IV trials occur after drug approval, monitoring long-term effects and safety in the general population, known as post-marketing research. Choice A is incorrect as bioavailability is studied earlier, like phase I. Choice C is wrong because safety and efficacy are pre-approval (phases I-III). Choice D is incorrect since phase IV isn't animal-based—it's post-approval human study.
Strategies to monitor controlled substance use include:
- A. Prescription drug monitoring programs
- B. Patient education
- C. Urine drug screening
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because PDMPs track prescriptions, education informs risks, and urine screening detects misuse—all key monitoring tools per guidelines. Choice A is incorrect alone as it's one method. Choice B is wrong by itself because education is just part. Choice C is incorrect solo since screening is only one approach.