Nokea
The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?
- A. Pregnant women
- B. Elderly men
- C. Overweight or obese patients
- D. Patients with multiple comorbidities
Correct Answer: C
Rationale: Overweight/obese patients may need higher warfarin doses due to larger volume of distribution; pregnancy contraindicates warfarin.
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A nurse is preparing to administer a prescribed medication to a client. The nurse integrates knowledge of which of the following as a possible factor that could influence the drug response?
- A. Age
- B. Polypharmacy
- C. Weight
- D. All the above
Correct Answer: D
Rationale: Drug response can be influenced by the following factors: age, polypharmacy, weight, sex, disease, and genetics.
You are to infuse 1,200 mL of IV fluid over 6 hours using a drop factor of 10 gtt/mL. What is the flow rate in drops per minute?
- A. 30 gtt/min
- B. 33 gtt/min
- C. 40 gtt/min
- D. 50 gtt/min
Correct Answer: B
Rationale: Flow rate = (1,200 mL 10 gtt/mL) ÷ (6 60) = 12,000 ÷ 360 = 33.33 gtt/min, rounded to 33 gtt/min.
When using a bar-code point-of-care medication system, the nurse would scan which of the following prior to drug administration?(Select one that does not apply.)
- A. Client's hospital chart
- B. Client's identification band
- C. Drug unit dose package
- D. Nurse's identification badge
Correct Answer: A
Rationale: The bar-code point-of-care medication system requires that the client's identification band, the drug unit dose package, and the nurse's identification badge are all scanned prior to drug administration.
A patient tells the clinic nurse that he or she has been taking over-the-counter (OTC) Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this issue to a health care provider. As part of the teaching plan for this patient, the nurse explains what risk associated with not sharing OTC drug use with the provider?
- A. The OTC drug could be more expensive than seeking health care advice.
- B. The drug could mask symptoms of a serious problem that is undiagnosed.
- C. Use of the drug could cause a rebound effect of Pepcid.
- D. The drug could interact with several cold medicines.
Correct Answer: B
Rationale: OTC drugs allow patients to self-diagnose and treat routine signs and symptoms without seeing a health care provider. This self-prescribed treatment, however, could mask a more serious underlying medical problem and result in a poor outcome for the patient. The issues of drug rebound and drug interaction need to be considered, but the safety issue related to self-diagnosis and self-prescription presents the greatest risk to the patient. Patients should always be encouraged to discuss the use of OTC products with their health care provider.
The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patient's pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening?
- A. Tolerance
- B. Cumulation
- C. Interactions
- D. Addiction
Correct Answer: A
Rationale: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance.