Nokea
The following are anticoagulants that do not require monitoring of INR:
- A. Rivaroxaban
- B. Apixaban
- C. Dabigatran
- D. All of the above
Correct Answer: D
Rationale: These are direct oral anticoagulants (DOACs), which do not require regular INR monitoring.
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A 48-year-old woman pricks her finger on a rose bush while pruning. A few days later, she develops small, red lesions near the wound and a red track ascending her hand toward her trunk. Her doctor prescribes itraconazole for the sporotrichosis. What is the mechanism of action of this medication?
- A. Disrupts fungal cell membrane by forming pores (nystatin, amphotericin B)
- B. Disrupts fungal microtubules (griseofulvin)
- C. Inhibits conversion of lanosterol to ergosterol
- D. Inhibits squalene monooxygenase (terbinafine)
Correct Answer: C
Rationale: Sporotrichosis, from Sporothrix schenckii, requires antifungals like itraconazole. Option , inhibiting lanosterol to ergosterol conversion, is correct-itraconazole blocks 14-α-demethylase, disrupting fungal membrane synthesis. Option , pore formation, is amphotericin B's mechanism. Option , microtubule disruption, is griseofulvin's. Option , squalene monooxygenase inhibition, is terbinafine's. Option (E), 5-FU conversion, is flucytosine's. Itraconazole's ergosterol inhibition effectively treats this subcutaneous infection, targeting fungal viability.
Acyclovir has been ordered for a patient with genital herpes. Which nursing interventions are appropriate for this patient? (Select all that apply.)
- A. Monitor the patient’s blood urea nitrogen and creatinine.
- B. Monitor the patient’s blood pressure for hypertension.
- C. Administer intravenous acyclovir over 30 minutes.
- D. Advise maintenance of adequate fluid intake.
Correct Answer: A
Rationale: Acyclovir can cause nephrotoxicity, so monitoring blood urea nitrogen (BUN) and creatinine levels is essential. Hypertension is not a common side effect of acyclovir. Intravenous acyclovir should be administered over at least 1 hour to prevent renal toxicity. Adequate fluid intake helps prevent crystalluria and nephrotoxicity.
The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
- A. Increased heart rate
- B. Increased blood vessel dilation
- C. Increased force of cardiac contractions
- D. Increased conduction of electrical impulses across the heart
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor that works by increasing the levels of cyclic adenosine monophosphate (cAMP) within cardiac myocytes. This leads to enhanced calcium influx into the cells, ultimately resulting in increased force of cardiac contractions (positive inotropic effect). This increased contractility helps improve cardiac output without necessarily increasing heart rate or affecting blood vessel dilation.
ACE inhibitors…
- A. Block the vasoconstrictor and aldosterone from producing effects of angiotensin II at the receptor site
- B. Blocks stimulation of beta 1 and beta 2 at the receptor sites
- C. Blocks the conversion of angiotensin I to the vasoconstrictor angiotensin II
- D. None of the above
Correct Answer: A
Rationale: ACE inhibitors, such as enalapril and lisinopril, work by blocking the enzyme angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I into angiotensin II. By inhibiting this conversion, ACE inhibitors prevent the vasoconstrictor and aldosterone-stimulating effects of angiotensin II at the receptor sites. This leads to vasodilation, decreased blood pressure, and reduced aldosterone secretion. This mechanism of action makes ACE inhibitors an important class of medications for managing conditions such as hypertension, heart failure, and chronic kidney disease.
An adolescent client will receive Depo-Provera as a method of birth control. She asks the nurse how long the drug will be effective. What is the best response by the nurse?
- A. 2 months
- B. 6 months
- C. 1 year
- D. 3 months
Correct Answer: D
Rationale: Depo-Provera, a progestin injection, provides contraception by inhibiting ovulation for 3 months , requiring re-administration every 12 weeks. This duration is based on its pharmacokinetic profile, ensuring reliable hormone levels. Two months underestimates, risking unprotected gaps. Six months or 1 year overestimate, reducing efficacy mid-cycle. The nurse's accurate response (D) educates the client on timing, ensuring adherence and preventing unintended pregnancy, aligning with clinical standards for injectable contraceptives.