Nokea
The nurse is caring for a client diagnosed with heart failure who is taking digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse monitor for?
- A. Hypertension
- B. Bradycardia
- C. Hyperglycemia
- D. Insomnia
Correct Answer: B
Rationale: The correct answer is B: Bradycardia. Bradycardia is a common sign of digoxin toxicity, as digoxin can cause decreased heart rate. Therefore, monitoring the client for signs of bradycardia is crucial. Choices A, C, and D are incorrect. Hypertension is not typically associated with digoxin toxicity; instead, hypotension may occur. Hyperglycemia is not a common sign of digoxin toxicity. Insomnia is also not a typical sign of digoxin toxicity; instead, some patients may experience visual disturbances, confusion, or other neurological symptoms.
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Food or drink that should be avoided when taking a prescription for simvastatin includes:
- A. Milk
- B. Orange juice
- C. Grapefruit juice
- D. Green leafy vegetables
Correct Answer: C
Rationale: Choice C is correct because grapefruit juice inhibits CYP3A4, which metabolizes simvastatin, increasing drug levels and rhabdomyolysis risk, so it's to be avoided. Choice A is incorrect as milk doesn't affect simvastatin significantly. Choice B is wrong because orange juice has no notable interaction. Choice D is incorrect since green leafy vegetables don't impact simvastatin metabolism.
The client has been prescribed warfarin (Coumadin) and is being educated about dietary restrictions. Which food should the client be advised to avoid or eat in consistent amounts?
- A. Bananas
- B. Spinach
- C. Oranges
- D. Yogurt
Correct Answer: B
Rationale: Spinach is high in vitamin K, which can interfere with the effectiveness of warfarin. It is important for clients taking warfarin to maintain consistent levels of vitamin K intake to ensure the medication works properly. Foods rich in vitamin K, such as spinach, can counteract the effects of warfarin, leading to potential complications. Therefore, clients on warfarin are advised to either avoid or consume vitamin K-rich foods, like spinach, in consistent amounts to maintain the medication's efficacy. Bananas, oranges, and yogurt are not high in vitamin K and do not significantly impact the effectiveness of warfarin, making them safe options for clients taking this medication.
The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had chickenpox as a child. The NP should:
- A. obtain a varicella titer.
- B. administer the Varivax vaccine.
- C. give the patient the Zostavax vaccine.
- D. plan to prescribe Zovirax if the patient is exposed to shingles.
Correct Answer: C
Rationale: The correct answer is C because Zostavax is recommended for adults over 60 to prevent shingles, regardless of prior chickenpox. Choice A is incorrect (titer not needed). Choice B is wrong (Varivax not for shingles). Choice D is inaccurate (prophylaxis not standard).
Nurse practitioner prescriptive authority is regulated by:
- A. The National Council of State Boards of Nursing
- B. The U.S. Drug Enforcement Administration
- C. The State Board of Nursing for each state
- D. The State Board of Pharmacy
Correct Answer: C
Rationale: The correct answer is choice C, the State Board of Nursing for each state, because these boards establish the legal scope of practice for nurse practitioners, including prescriptive authority, which varies by state due to differing regulations. Choice A, the National Council of State Boards of Nursing, is incorrect as it provides guidelines and licensure standards but doesn't directly regulate state-specific authority. Choice B, the U.S. Drug Enforcement Administration, is wrong because it oversees controlled substances, not general prescribing rights. Choice D, the State Board of Pharmacy, is also incorrect since it governs pharmacists, not NPs, and has no jurisdiction over their prescriptive authority.
Men may require higher doses of which drug class due to differences in body composition?
- A. Lipid-soluble drugs
- B. Water-soluble drugs
- C. Drugs that are highly protein bound
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because men's greater lean mass dilutes water-soluble drugs, often requiring higher doses for efficacy, unlike others. Choice A is incorrect as lipid-soluble drugs align with fat, lower in men. Choice C is wrong because protein binding isn't sex-specific here. Choice D is incorrect since only water-soluble drugs apply.