Nokea
Several processes enable a drug to reach a specific concentration in the body. Together they are called dynamic equilibrium. What are these processes? (Select one that does not apply.)
- A. Distribution to the active site
- B. Biotransformation
- C. Absorption from the muscle
- D. Excretion
Correct Answer: C
Rationale: The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes: Absorption from the site of entry (can be from the muscle, the gastrointestinal (GI) tract if taken orally, of the subcutaneous tissue if given by that route); Distribution to the active site; biotransformation (metabolism) in the liver; excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium.
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A nurse is preparing a prescribed dose of rabeprazole for a client with gastric ulcers. The nursing drug guide does not list treatment of gastric ulcers among the recognized indications for this drug. What should the nurse do?
- A. Administer the drug as ordered
- B. Clarify with the prescriber concerning the ordered drug
- C. Document this potential error in the client's health record
- D. Ask the client whether he or she has taken this drug before
Correct Answer: B
Rationale: Rabeprazole is typically for GERD, not gastric ulcers per standard indications; clarifying with the prescriber ensures safety and appropriateness.
The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?
- A. Pancreatitis
- B. Diabetes mellitus
- C. Myocardial infarction
- D. Chronic obstructive pulmonary disease
Correct Answer: A
Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.
Patients who have a poor metabolism phenotype will have:
- A. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
- B. Accumulation of inactive metabolites of drugs
- C. A need for increased dosages of medications
- D. Increased elimination of an active drug
Correct Answer: A
Rationale: Poor metabolizers (e.g., CYP2D6) slowly convert prodrugs to active forms , causing prodrug buildup, not metabolite accumulation or faster elimination .
A nurse is providing teaching to a client who has a new prescription for Amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching?
- A. Expect therapeutic effects in 24 to 48 hr.
- B. Discontinue the medication after a week of improved mood.
- C. Change positions slowly to minimize dizziness.
- D. Decrease injury from the first dose.
Correct Answer: C
Rationale: Slow position changes prevent dizziness, and chewing gum relieves dry mouth, common with tricyclics like amitriptyline.
Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes:
- A. Fill the canal with the drops with each dose
- B. Some redness and itching around the ear canal is normal
- C. Warm the bottle of ear drops in his or her hand before administering
- D. Cipro HC otic may cause ototoxicity
Correct Answer: C
Rationale: Warming Cipro HC improves comfort; filling or ototoxicity aren't standard advice.