Nokea
Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated?
- A. Tinnitus
- B. Diarrhea
- C. Hearing loss
- D. Photosensitivity
Correct Answer: A
Rationale: Tinnitus is an early sign of aspirin toxicity (salicylism); diarrhea or photosensitivity are less specific, and hearing loss is later.
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A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred vision. He is currently on digoxin for the treatment of heart failure. On physical exam, his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which parameter is used to indicate the ability of digoxin to produce the desired effect relative to a toxic effect?
- A. Bioavailability
- B. Efficacy
- C. Intrinsic activity
- D. Therapeutic index
Correct Answer: D
Rationale: Therapeutic index (TI) measures the relative safety of a drug by comparing the dose required for a therapeutic effect to the dose that produces toxicity. In this case, digoxin toxicity is indicated by the elevated level, and TI is the relevant parameter.
All the following cross placenta except
- A. Warfarin
- B. Heparin
- C. Phenindione
- D. Morphine
Correct Answer: B
Rationale: Heparin, a large molecule, does not cross the placenta; others do.
A 27-year-old man is admitted to the emergency department (ED) after a serious motorcycle accident. The patient has a head injury, abrasions covering the left side of his body, a broken left femur, and internal injuries that are not fully assessed at this time. He is transferred from the ED to the intensive care unit (ICU). The nurse who is going to care for this patient in the ICU knows that a priority responsibility in regard to drug therapy is what?
- A. Support vital functions
- B. Continue curative treatment
- C. Institute life-saving treatment
- D. Monitor patient's response
Correct Answer: D
Rationale: Monitoring response ensures therapy adjusts to the patient's critical condition, a priority in ICU.
Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
- A. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
- B. For pedal edema throughout therapy
- C. Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
- D. For vision changes, such as red-green blindness, at least annually
Correct Answer: A
Rationale: Phenytoin hypersensitivity syndrome can occur 3-8 weeks post-initiation.
An overdose of amitriptyline may precipitate all the following adverse effects EXCEPT:
- A. Cardiac arrhythmias
- B. Hypotension
- C. Sedation
- D. Jaundice
Correct Answer: D
Rationale: Amitriptyline overdose does not typically cause jaundice; it causes anticholinergic and cardiac effects.