Nokea
Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
- A. After the second dose
- B. After four to five half-lives
- C. When the patient feels the full effect of the drug
- D. One hour after IV administration
Correct Answer: B
Rationale: Choice B is correct because steady state is reached after four to five half-lives, when absorption equals elimination, stabilizing drug levels for therapeutic monitoring. Choice A is incorrect as the second dose is too early for steady state. Choice C is wrong because patient perception doesn't define pharmacokinetics. Choice D is incorrect since IV timing varies and doesn't inherently match steady state.
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Drugs that may require lower doses in the elderly include:
- A. Acetaminophen
- B. Amitriptyline
- C. Amoxicillin
- D. All of the above
Correct Answer: C
Rationale: Choice C is correct because amoxicillin requires lower doses in the elderly due to decreased renal function, reducing clearance and risking toxicity. Choice A is incorrect as acetaminophen doses are standard unless liver issues exist. Choice B is wrong because amitriptyline is avoided, not just lowered. Choice D is incorrect since only amoxicillin typically needs adjustment.
A client has been prescribed ciprofloxacin and is receiving discharge teaching. Which of the following instructions should be included by the healthcare provider?
- A. Take the medication with milk.
- B. Avoid exposure to sunlight.
- C. Take the medication at bedtime.
- D. Increase your intake of vitamin K.
Correct Answer: B
Rationale: The correct answer is to instruct the client to avoid exposure to sunlight. Ciprofloxacin can increase the risk of photosensitivity, making it important to protect the skin from sunlight to prevent skin reactions. This precaution can help prevent skin damage and discomfort in individuals taking ciprofloxacin. Choices A, C, and D are incorrect. Taking ciprofloxacin with milk is not recommended as it may reduce the absorption of the medication. There is no specific instruction to take ciprofloxacin at bedtime. Increasing vitamin K intake is not directly related to ciprofloxacin therapy.
Herbal products that should be avoided when a patient is taking warfarin include:
- A. Ginkgo biloba
- B. Echinacea
- C. Valerian root
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because ginkgo biloba has antiplatelet effects, enhancing warfarin's anticoagulation and bleeding risk, so it should be avoided. Choice B is incorrect as echinacea doesn't significantly interact with warfarin. Choice C is wrong because valerian root's sedative effects don't notably affect anticoagulation. Choice D is incorrect since only ginkgo biloba poses a clear risk.
The parents of a 2-month-old infant ask the primary care nurse practitioner (NP) if they can immunize their child by giving one or two immunizations per month instead of following the recommended immunization schedule for vaccines at 2, 4, 6, 12, and 15 months of age. The NP should:
- A. respect the parents' wishes and agree to the revised schedule for immunizations.
- B. explain that prolonging the vaccine regimen will lead to a decrease in final antibody concentrations.
- C. tell the parents that protection from diseases may be delayed until all immunizations have been given.
- D. inform the parents that a prolonged interval between some vaccines may require restarting the series for those vaccines.
Correct Answer: C
Rationale: The correct answer is C because delaying vaccines postpones protection, critical for vulnerable infants. Choice A is incorrect (safety trumps preference). Choice B is wrong (longer intervals don’t reduce antibodies). Choice D is inaccurate (restart not usually required).
Drugs that are commonly used off-label include:
- A. Gabapentin
- B. Amitriptyline
- C. Quetiapine
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because gabapentin (e.g., anxiety), amitriptyline (e.g., pain), and quetiapine (e.g., insomnia) are often used off-label, supported by evidence, per clinical practice. Choice A is incorrect alone as it's one drug. Choice B is wrong by itself because amitriptyline is just part. Choice C is incorrect solo since quetiapine is only one agent.