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When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
- A. The sum of the effects of each drug individually
- B. Greater than the sum of the effects of each drug individually
- C. Less than the effect of each drug individually
- D. Not predictable, as it varies with each individual
Correct Answer: B
Rationale: Choice B is correct because synergy means the combined effect exceeds the sum of individual effects, enhancing therapeutic outcomes beyond additive results. Choice A is incorrect as it describes an additive, not synergistic, effect. Choice C is wrong because synergy doesn't reduce efficacy below individual effects. Choice D is incorrect since synergy is a predictable pharmacological principle, not entirely variable.
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A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. What should the nurse do first?
- A. Call a code blue.
- B. Call the healthcare provider.
- C. Check the client's status and lead placement.
- D. Press the recorder button on the ECG console.
Correct Answer: C
Rationale: The correct first action for the nurse to take is to check the client's status and lead placement. This step is crucial to ensure that the alarm is not triggered by a simple issue such as lead displacement. Calling a code blue (choice A) is premature without assessing the client first. Contacting the healthcare provider (choice B) can be done after ruling out basic causes for the alarm. Pressing the recorder button (choice D) is not as urgent as checking the client's status and lead placement in this scenario.
What is the initial action the nurse should take for a client who had a myocardial infarction (MI) and is experiencing restlessness, agitation, and an increased respiratory rate?
- A. Administer oxygen.
- B. Administer morphine sulfate.
- C. Notify the healthcare provider.
- D. Take the client's blood pressure.
Correct Answer: A
Rationale: Administering oxygen is the priority action for a client experiencing restlessness, agitation, and an increased respiratory rate after a myocardial infarction (MI). This intervention helps ensure adequate oxygenation, improve cardiac function, and reduce the workload on the heart. Oxygen therapy takes precedence over administering medications like morphine sulfate or notifying the healthcare provider as it addresses the immediate need for oxygenation. Checking the blood pressure is also important but not as urgent as ensuring proper oxygen supply.
Signs of tolerance include:
- A. Needing higher doses for the same effect
- B. Reduced side effects over time
- C. Increased sensitivity to the drug
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because tolerance is defined by needing more drug for the same effect due to body adaptation, per pharmacokinetic principles. Choice B is incorrect as reduced side effects may occur but aren't the definition. Choice C is wrong because sensitivity decreases, not increases. Choice D is incorrect since only A fits.
Therapeutic drug monitoring would be appropriate for which drug?
- A. Acetaminophen
- B. Phenytoin
- C. Albuterol
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because phenytoin has a narrow therapeutic index, requiring monitoring of peak and trough levels to ensure efficacy and avoid toxicity, unlike broader-range drugs. Choice A is incorrect as acetaminophen's wide safety margin and short-term use don't typically need monitoring. Choice C is wrong because albuterol's inhaled route and rapid action don't require blood level checks. Choice D is incorrect since only phenytoin fits the monitoring profile.
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.