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The client needs instruction on using a metered-dose inhaler (MDI). Which instruction should be given?
- A. Inhale the medication and then exhale immediately
- B. Exhale fully, then place the inhaler in your mouth and inhale deeply while pressing the canister
- C. Take two short breaths before inhaling the medication
- D. Hold your breath for 5 seconds after inhaling the medication
Correct Answer: B
Rationale: The correct technique for using a metered-dose inhaler (MDI) involves exhaling fully before inhaling deeply while pressing the canister to ensure effective delivery of the medication. Choice A is incorrect as exhaling should precede inhaling. Choice C is incorrect as taking two short breaths is not part of the correct technique. Choice D is incorrect as there is no need to hold the breath for a specific time after inhaling the medication.
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A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure is still stable, what should the nurse do next?
- A. Administer another nitroglycerin tablet.
- B. Apply 1 to 3 L/minute of oxygen via nasal cannula.
- C. Call for a 12-lead electrocardiogram (ECG) to be performed.
- D. Wait an additional 5 minutes, then give a second nitroglycerin tablet.
Correct Answer: A
Rationale: When a client with angina pectoris continues to experience chest pain despite initial nitroglycerin administration and stable blood pressure, the appropriate next step is to administer another nitroglycerin tablet. This helps to further dilate coronary arteries, improving blood flow to the heart muscle and relieving chest pain. Applying oxygen via nasal cannula (Choice B) may be necessary if the client displays signs of respiratory distress or hypoxemia, but in this case, the priority is addressing the unresolved chest pain. Calling for a 12-lead electrocardiogram (ECG) (Choice C) is important to assess for any changes in the client's cardiac status, but administering another nitroglycerin tablet takes precedence in managing the ongoing chest pain. Waiting an additional 5 minutes before giving a second nitroglycerin tablet (Choice D) may delay symptom relief and potentially worsen the client's condition if the chest pain persists.
Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
- A. Protein malnutrition
- B. Iron-deficiency anemia
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: A
Rationale: Choice A is correct because phase I metabolism, involving cytochrome P450 enzymes, relies on protein for enzyme synthesis; malnutrition impairs this, reducing metabolism. Choice B is incorrect as iron deficiency affects oxygen transport, not directly phase I processes. Choice C is wrong since only protein malnutrition, not iron deficiency, is directly relevant. Choice D is incorrect because protein malnutrition does impact metabolism.
A primary care NP is preparing to prescribe a fluoroquinolone for a patient who has a history of alcohol abuse that has caused liver damage. The NP should choose:
- A. norfloxacin.
- B. levofloxacin.
- C. gemifloxacin.
- D. ciprofloxacin.
Correct Answer: B
Rationale: The correct answer is B because levofloxacin has lower hepatic risk, safer for liver-damaged patients. Choices A, C, and D are incorrect (higher hepatic risk).
Drugs that should be avoided in transgender men receiving testosterone therapy include:
- A. Estrogen
- B. Alpha blockers
- C. Beta blockers
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because estrogen counteracts testosterone's masculinizing effects in transgender men, conflicting with therapy aims, so it's avoided. Choice B is incorrect as alpha blockers don't interfere with testosterone goals. Choice C is wrong because beta blockers are unrelated to therapy effects. Choice D is incorrect since only estrogen applies.
Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known:
- A. Teratogens
- B. Carcinogens
- C. To cause hypersensitivity reactions
- D. Hypothalamus-pituitary-adrenal axis suppressants
Correct Answer: B
Rationale: Choice B is correct because azathioprine's type D ADR (delayed) relates to its carcinogenic potential, like leukemia, emerging years after use. Choice A is incorrect as teratogenicity is a separate risk, not type D's focus. Choice C is wrong because hypersensitivity is type B, not delayed. Choice D is incorrect since it suppresses immunity, not the HPA axis directly.