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To reduce medication errors, the Institute of Safe Medication Practices recommends:
- A. Using only brand names on prescriptions
- B. Avoiding the use of 'tall man' lettering
- C. Avoiding the use of error-prone abbreviations
- D. Using decimals instead of fractions when prescribing
Correct Answer: C
Rationale: Choice C is correct because the ISMP recommends avoiding error-prone abbreviations (e.g., ‘U' for units) to prevent misinterpretation and errors, a proven safety strategy. Choice A is incorrect as brand names alone don't reduce errors—generics are standard. Choice B is wrong because ‘tall man' lettering (e.g., LisinOPRIL) helps, not harms. Choice D is incorrect since decimals can confuse (e.g., .5 vs. 0.5)—whole numbers are safer.
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Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):
- A. A 32-year-old male
- B. A 22-year-old female
- C. A 3-month-old female
- D. A 48-year-old male
Correct Answer: C
Rationale: Choice C is correct because a 3-month-old female is at higher risk for ADRs due to immature liver and kidney function, reducing drug metabolism and excretion, increasing toxicity potential. Choice A is incorrect as a healthy 32-year-old male typically has mature systems. Choice B is wrong because a 22-year-old female also has developed metabolism. Choice D is incorrect since a 48-year-old male, unless compromised, has lower risk than an infant.
The client is receiving heparin therapy for deep vein thrombosis (DVT). Which lab test should be monitored to evaluate the effectiveness of heparin?
- A. Prothrombin time (PT)
- B. International normalized ratio (INR)
- C. Activated partial thromboplastin time (aPTT)
- D. Fibrinogen levels
Correct Answer: C
Rationale: Activated partial thromboplastin time (aPTT) is the appropriate lab test to monitor the therapeutic effectiveness of heparin therapy. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure the client is within the therapeutic range to prevent clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, a different anticoagulant that affects the extrinsic pathway of the coagulation cascade. Fibrinogen levels are not specific to monitoring heparin therapy.
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).
Risks to the fetus in the second trimester include:
- A. Exposure to teratogens causing abnormal organ development
- B. Maternal use of tobacco causing intrauterine growth restriction
- C. Maternal hypertension causing placental insufficiency
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because the second trimester involves growth, and tobacco restricts it via vasoconstriction, a key risk then. Choice A is incorrect as teratogens primarily affect organ development in the first trimester. Choice C is wrong because hypertension's placental effects are more third-trimester prominent. Choice D is incorrect since B is the specific second-trimester concern.
Risk factors for drug abuse include:
- A. Family history of addiction
- B. Mental health disorders
- C. Peer pressure
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because family history (genetic predisposition), mental health issues (self-medication), and peer pressure (social influence) are all established risk factors, per SAMHSA. Choice A is incorrect alone as it's one factor. Choice B is wrong by itself because mental health is just part. Choice C is incorrect solo since pressure is only one element.