Nokea
Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
- A. Toxic levels of warfarin building up
- B. Decreased response to warfarin
- C. Increased risk for significant drug interactions with warfarin
- D. Less risk of drug interactions with warfarin
Correct Answer: B
Rationale: VCORC1 mutations reduce warfarin's anticoagulant effect , requiring higher doses, not toxicity or interaction changes .
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A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred vision. He is currently on digoxin for the treatment of heart failure. On physical exam, his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which parameter is used to indicate the ability of digoxin to produce the desired effect relative to a toxic effect?
- A. Bioavailability
- B. Efficacy
- C. Intrinsic activity
- D. Therapeutic index
Correct Answer: D
Rationale: Therapeutic index (TI) measures the relative safety of a drug by comparing the dose required for a therapeutic effect to the dose that produces toxicity. In this case, digoxin toxicity is indicated by the elevated level, and TI is the relevant parameter.
The nurse, providing patient teaching about home medication use to an older adult, explains that even when drugs are taken properly they can produce negative or unexpected effects. What are these negative or unexpected effects called?
- A. Teratogenic effects
- B. Toxic effects
- C. Adverse effects
- D. Therapeutic effects
Correct Answer: C
Rationale: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Therapeutic effects are the desired actions for which the medication is prescribed.
You are evaluating the discharge teaching you have done with your patient concerning their drug therapy. What statement from the patient would indicate that teaching had been effective?
- A. I have to take three pills each day. It doesn't matter when.'
- B. I should take the white pill in the morning and the green pill in the afternoon. I don't know what they are called.'
- C. I need to tell all my other doctors that I am taking this Coumadin because it could interact with other drugs.'
- D. I think I could cut that pill in half if I wanted to.'
Correct Answer: C
Rationale: Understanding drug interactions with Coumadin (warfarin) shows effective teaching on safety and coordination of care.
A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take?
- A. Obtain an order for BUN and creatinine levels
- B. Reassure the patient that this is a harmless effect
- C. Request an order for a urinalysis
- D. Test her urine for occult blood
Correct Answer: B
Rationale: Reddish-brown urine is a benign metronidazole side effect; no labs are needed. Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.
Which of the following can be used with parenteral route for the treatment of diabetes mellitus
- A. Insulin preparations
- B. Sulfonilureas
- C. Biguanides
- D. Acarbose
Correct Answer: A
Rationale: Insulin is the only diabetes medication administered parenterally (e.g., subcutaneous or IV).