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.
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Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
- A. Fluoxetine (Prozac)
- B. Paroxetine (Paxil)
- C. Amitriptyline (Elavil)
- D. Duloxetine (Cymbalta)
Correct Answer: D
Rationale: Duloxetine addresses both depression and fatigue, unlike sedating options.
Etidronate is prescribed for a postmenopausal woman who is at great risk for developing osteoporosis. Which of the following adverse effects to this drug is the patient most likely to experience?
- A. Tetany
- B. Cholelithiasis
- C. Esophagitis
- D. Renal damage from calcium stone formation
Correct Answer: C
Rationale: Bisphosphonates like etidronate commonly cause esophagitis if not taken properly.
The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein-binding sites, what would this do?
- A. Make the patient gentamicin deficient
- B. Make the patient fluconazole deficient
- C. Counteract any positive benefit the drugs would have
- D. Alter the effectiveness of both drugs
Correct Answer: D
Rationale: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other.
A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
- A. Calcium chloride
- B. Calcium gluconate
- C. Calcitonin (Miacalcin)
- D. Large doses of vitamin D
Correct Answer: C
Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.
A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce
- A. disease relapse
- B. drug hypersensitivity reactions
- C. drug resistance
- D. drug adverse effects
Correct Answer: C
Rationale: Multi-drug therapy prevents TB resistance; it doesn't directly reduce relapse , hypersensitivity , or side effects . Without multi-drug therapy, patients easily develop resistance to antitubercular drugs.