Nokea
VKORC1 genetic variations would affect which drug?
- A. Warfarin
- B. Codeine
- C. Acetaminophen
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because VKORC1 variants alter warfarin's target enzyme, affecting its anticoagulant effect and requiring dose adjustments. Choice B is incorrect as codeine's action is CYP2D6-mediated, not VKORC1-related. Choice C is wrong because acetaminophen doesn't interact with VKORC1—it's unrelated to coagulation. Choice D is incorrect since only warfarin is impacted by VKORC1 genetics.
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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.
When determining drug treatment, the NP prescriber should:
- A. Always use evidence-based guidelines
- B. Individualize the drug choice for the specific patient
- C. Rely on his or her experience when prescribing for complex patients
- D. Use the newest drug on the market for the condition being treated
Correct Answer: B
Rationale: Choice B is correct because tailoring treatment to the patient's unique factors—age, comorbidities, preferences—optimizes efficacy and safety. Choice A is incorrect as guidelines inform but don't dictate every case. Choice C is wrong because experience alone may lack evidence support. Choice D is incorrect since newest drugs aren't always best—evidence and patient fit matter more.
The client with atrial fibrillation is receiving warfarin (Coumadin). Which laboratory test should be monitored to determine the effectiveness of the therapy?
- A. Prothrombin time (PT) and international normalized ratio (INR)
- B. Activated partial thromboplastin time (aPTT)
- C. Complete blood count (CBC)
- D. Fibrinogen level
Correct Answer: A
Rationale: Monitoring Prothrombin time (PT) and international normalized ratio (INR) is crucial when a client is on warfarin therapy. These tests assess the clotting ability of the blood and help determine the appropriate dosage of warfarin to prevent complications such as bleeding or clotting events. PT and INR values within the therapeutic range indicate the effectiveness of warfarin in managing atrial fibrillation. Choice B, activated partial thromboplastin time (aPTT), is not typically used to monitor warfarin therapy; it is more commonly used to assess the effectiveness of heparin therapy. Choice C, complete blood count (CBC), does not directly assess the anticoagulant effect of warfarin. Choice D, fibrinogen level, is not a primary test for monitoring warfarin therapy; it is more relevant in assessing conditions like disseminated intravascular coagulation.
Drugs that should be avoided in the elderly include:
- A. Acetaminophen
- B. Amitriptyline
- C. Amoxicillin
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because amitriptyline, a tricyclic antidepressant, is avoided in the elderly (per Beers Criteria) due to anticholinergic effects causing confusion, constipation, and falls. Choice A is incorrect as acetaminophen is safe. Choice C is wrong because amoxicillin is appropriate with dose adjustment. Choice D is incorrect since only amitriptyline fits.
A client with a history of congestive heart failure (CHF) is receiving digoxin (Lanoxin). The nurse should monitor the client for which sign of digoxin toxicity?
- A. Hypertension
- B. Bradycardia
- C. Hyperglycemia
- D. Insomnia
Correct Answer: B
Rationale: Bradycardia is a common sign of digoxin toxicity. Digoxin can cause bradycardia due to its effects on the heart's electrical conduction system. The nurse should closely monitor the client's heart rate for any signs of slowing down, as it can indicate toxicity and potentially lead to serious complications. Hypertension, hyperglycemia, and insomnia are not typically associated with digoxin toxicity. Hypertension is more commonly associated with other conditions or medications, hyperglycemia can be seen in conditions like diabetes or certain medications, and insomnia is not a typical sign of digoxin toxicity.