Nokea
The 'donut hole' in Medicare Part D:
- A. Will be totally eliminated with the federal health-care reform enacted in 2010
- B. Refers to the period of time when annual individual drug costs are between 250 and 2,250 per year and drug costs are covered 75%
- C. Refers to the period between when the annual individual drug costs are 2,970 and 4,750 and the patient pays 52.5% of the costs of brand name drugs (2013)
- D. Has no effect on whether patients continue to fill their prescriptions during the coverage gap
Correct Answer: C
Rationale: The donut hole (2013) is the coverage gap where patients pay more out-of-pocket.
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A nurse is caring for a group of clients who are not protected against Varicella. The nurse should prepare to administer the Varicella vaccine at this time to which of the following clients?
- A. 24-year-old woman in the third trimester of pregnancy
- B. 12-year-old child who has a severe allergy to neomycin
- C. 2-month-old infant who has no health problems
- D. 32-year-old man who has essential hypertension
Correct Answer: D
Rationale: Varicella vaccine is safe for the 32-year-old ; it's contraindicated in pregnancy, neomycin allergy, and infants under 1 year.
The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again?
- A. 1 hours after the original dose
- B. 2 hours after the original dose
- C. 3 hours after the original dose
- D. 4 hours after the original dose
Correct Answer: C
Rationale: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours.
A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss
- A. a chest x-ray
- B. a TB skin test
- C. liver function tests (LFTs)
- D. prophylactic antitubercular drugs
Correct Answer: B
Rationale: TB exposure requires a skin test first; chest x-ray follows if positive, and LFTs or prophylaxis aren't initial steps. Patients who have exposure to TB should have a TB skin test.
The volume of distribution (Vd) for a drug that is completely retained in the vascular compartment would be?
- A. High
- B. Low
- C. Unchanged
- D. Cannot be determined
Correct Answer: B
Rationale: A drug confined to the vascular compartment (e.g., plasma) has a low Vd, close to plasma volume (about 0.06 L/kg), indicating limited distribution.
The patient is prescribed a medication that was just placed in Phase IV study. The patient tells the nurse, This medication is too expensive. Could the doctor order a generic form of this medication? What is the nurse's most accurate response?
- A. Medications are not produced in generic form until the patent expires, which normally takes several years.
- B. You can request the generic form but the binder used may make the drug less effective for this medication.
- C. The generic form of the medication would not be any less expensive because this is a relatively new medication.
- D. Generic medications are lower quality drugs and that would mean you would not be getting the best treatment available.
Correct Answer: A
Rationale: When a new drug enters the market, it is given a time-limited patent; generic forms of the medication cannot be produced until the patent expires. Because no generic version of this drug will exist because it is so new, it is impossible to predict what binder will be used or what the cost would be.