Nokea
The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin?
- A. Leafy green vegetables
- B. Dairy products
- C. Grapefruit juice
- D. Bran muffins
Correct Answer: D
Rationale: Step 1: Digoxin interacts with high-fiber foods like bran muffins, decreasing its absorption.
Step 2: Bran muffins can reduce the effectiveness of digoxin, leading to subtherapeutic levels.
Step 3: Avoiding bran muffins can help maintain optimal digoxin levels for therapeutic effect.
Summary: A - Leafy greens are okay; B - Dairy products don't interact significantly; C - Grapefruit juice can interact with certain medications, but not digoxin.
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Irbesartan (an angiotensin-II receptor antagonist) is contraindicated in:
- A. Left ventricular failure
- B. Asthma
- C. Bilateral renal artery stenosis
- D. Diabetic nephropathy
Correct Answer: C
Rationale: Irbesartan is contraindicated in bilateral renal artery stenosis (C) due to risk of renal failure and pregnancy (D) due to fetal harm; it is beneficial in heart failure (A) and diabetic nephropathy (E), and safe in asthma (B).
Which competitive neuromuscular blocking agent could be used in patients with renal failure?
- A. Atracurium
- B. Succinylcholine
- C. Pipecuronium
- D. Doxacurium
Correct Answer: A
Rationale: The correct answer is A: Atracurium. Atracurium is preferred in patients with renal failure because it is metabolized by Hoffman elimination independent of renal or hepatic function. Succinylcholine (B) is not recommended in renal failure due to prolonged paralysis. Pipecuronium (C) and Doxacurium (D) are primarily eliminated by renal excretion, making them unsuitable for patients with renal failure.
Beta-blocking drugs-induced chronically lower blood pressure may be associated with theirs effects on:
- A. The heart
- B. The blood vessels
- C. The renin-angiotensin system
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Beta-blocking drugs lower blood pressure by affecting multiple systems.
1. The heart: Beta blockers reduce heart rate and contractility, leading to decreased cardiac output.
2. The blood vessels: Beta blockers cause vasodilation, reducing peripheral resistance.
3. The renin-angiotensin system: Beta blockers can inhibit renin release, decreasing angiotensin II levels and reducing vasoconstriction.
Therefore, the effects of beta blockers on the heart, blood vessels, and renin-angiotensin system collectively result in chronically lower blood pressure. Choices A, B, and C are incorrect because beta blockers impact all these systems, not just one.
The constitutive COX-2 isoform tends to be homeostatic in function, while COX-1 is induced during inflammation and tends to facilitate the inflammatory response. The consideration is:
- A. TRUE
- B. FALSE
- C. None
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: FALSE. COX-1 is constitutively expressed and involved in homeostatic functions, while COX-2 is inducible during inflammation to facilitate the inflammatory response. COX-1 is responsible for maintaining normal physiological functions, such as protecting the stomach lining and regulating blood flow, while COX-2 is primarily involved in producing prostaglandins during inflammation. Therefore, COX-1 is not induced during inflammation, and COX-2 is not homeostatic. Choice A is incorrect because COX-1, not COX-2, is homeostatic. Choice C is incorrect because there is a clear distinction between the functions of COX-1 and COX-2. Choice D is incorrect because not all options are correct; only option B is accurate based on the roles of COX-1 and COX-2 in the body.
A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?
- A. Loop diuretics
- B. Osmotic diuretics
- C. Thiazide diuretics
- D. Vasodilators
Correct Answer: B
Rationale: The correct answer is B: Osmotic diuretics. Osmotic diuretics, like mannitol, are commonly used in the neurologic ICU to reduce intracranial pressure by drawing water out of the brain tissue and into the bloodstream, thus decreasing cerebral edema. Loop diuretics (A) are more commonly used for conditions like heart failure and kidney disease, not specifically for cerebral edema. Thiazide diuretics (C) are primarily used for conditions like hypertension and edema related to heart failure, not for reducing intracranial pressure. Vasodilators (D) work by dilating blood vessels and are not typically used as the first-line treatment for cerebral edema.