Nokea
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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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.
The nurse admits an older adult patient to the emergency room with reports of shortness of breath on exertion and a productive cough. The nurse reviews the patient's current medications and the patient says, I take one pink pill every morning. The nurse asks the name of the drug and the patient says she doesn't know. The patient cannot supply the name of the drug or the purpose in taking it either. This happens with four other medications the patient says she takes. What is an appropriate nursing diagnosis for this patient?
- A. Acute confusion
- B. Risk-prone health behavior
- C. Ineffective health maintenance
- D. Noncompliance
Correct Answer: C
Rationale: Lack of knowledge about medications indicates ineffective health maintenance, not acute confusion or noncompliance.
Following is the example of second generation antihistaminic:
- A. Diphenhydramine
- B. Promethazine
- C. Chlorpheniramine
- D. Cetirizine
Correct Answer: D
Rationale: Cetirizine is a second-generation antihistamine with less sedation due to reduced CNS penetration, unlike first-generation drugs like diphenhydramine, promethazine, and chlorpheniramine.
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.
The role of the NP in the use of herbal medication is to:
- A. Maintain competence in the prescribing of common herbal remedies
- B. Recommend common over-the-counter herbs to patients
- C. Educate patients and guide them to appropriate sources of care
- D. Encourage patients to not use herbal therapy due to the documented dangers
Correct Answer: C
Rationale: NPs should educate patients and guide them to safe herbal use, not universally discourage it.