Nokea
Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug might be absorbed. This process is known as:
- A. hepatic clearance.
- B. total clearance.
- C. enterohepatic cycling.
- D. first-pass effect.
Correct Answer: C
Rationale: Drugs and drug metabolites with molecular weights higher than 300 can be excreted via the bile, stored in the gallbladder, delivered to the intestines by the bile duct, and then reabsorbed into the circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body. Hepatic clearance is the amount of drug eliminated by the liver. Total clearance is the sum of all types of clearance including renal, hepatic, and respiratory. First-pass effect is the amount of drug absorbed from the GI tract, then metabolized by the liver (reducing the amount of drug that makes it into circulation).
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The nurse can promote relief of muscle pain, spasms, and tension by:
- A. having the client continue his activities as usual.
- B. immobilizing the client.
- C. applying heat, cold, pressure, or vibration to the painful area.
- D. giving as much pain medication as needed to ease the muscle.
Correct Answer: C
Rationale: Superficial heat and cold, massage, pressure, or vibration can be applied to alleviate pain associated with muscle tension, pain, or spasms.
When a couple experiencing infertility presents for a fertility workup, which of the following procedures should the nurse prepare the couple to have first?
- A. hysterosalpingography
- B. semen analysis
- C. endometrial biopsy
- D. transvaginal ultrasound
Correct Answer: B
Rationale: Because semen analysis is the least invasive of the tests listed and because in 35% of the cases the infertility is related to a male factor, semen analysis should be one of the first diagnostic tests performed. Hysterosalpingography fills the uterus and fallopian tubes with a radiopaque substance that can be seen with an X ray. It demonstrates tubal patency or any distortion of the uterine cavity. Endometrial biopsy provides information about the effects of progesterone after ovulation and the endometrial receptivity. Transvaginal ultrasound is mostly used in the treatment of infertility. For diagnosis it allows the endocrinologist to evaluate the developing follicle, assess oocyte maturity, and diagnose luteal phase defects. All the tests listed in Choices 1, 3, and 4 are more invasive, require greater expertise to evaluate and treat, and are more costly. If the semen analysis is normal, the couple can expect to progress through these tests as well.
A client has just returned from surgery where a femoral-popliteal bypass was performed. The nurse has assessed the client and is unable to feel a pulse at either the dorsalis pedis or the posterior tibial sites of the left foot. The foot feels warm and the color is pink. What action should the nurse perform next to prevent ischemia?
- A. Notify the physician immediately.
- B. Obtain a Doppler device to check for pulses, and notify the physician if they are still absent.
- C. Wait 30 minutes and recheck the pulses.
- D. Document the finding.
Correct Answer: B
Rationale: The nurse should immediately obtain a Doppler device and recheck the pulses. The dorsalis pedis and posterior tibial can be difficult to assess and might need to be verified with a Doppler. Because the client just had a surgery in which a complication is arterial insufficiency, the client must be monitored carefully. If the pulses are not found, the nurse should recognize that this is an emergent situation, and the physician must be notified immediately. If the nurse waits 30 minutes before determining if the pulses can be felt, this could compromise the viability of the client's foot due to ischemia. Documenting the findings is important but must be performed after the nurse locates the dorsalis pedis and posterior tibial pulses or any necessary interventions are made.
All of the following are clinical manifestations indicating male climacteric except:
- A. hot flashes.
- B. loss of reproductive ability.
- C. headaches.
- D. heart palpitations.
Correct Answer: B
Rationale: The likelihood of fathering children does decrease with aging and decreased testosterone production, but men do not lose their ability to reproduce during the climacteric. Many men do not experience any physical symptoms of climacteric but some men do report hot flashes, headaches, and heart palpitations, among other symptoms.
The primary organ for drug elimination is the:
- A. Skin
- B. Lung(s)
- C. Kidney(s)
- D. Liver
Correct Answer: C
Rationale: The kidneys are the primary organ for drug elimination, excreting most drugs or their metabolites in urine.