Nokea
Which of the following adverse effects are less likely in a beta1-selective blocker?
- A. Dysrhythmias
- B. Impaired insulin release
- C. Reflex orthostatic changes
- D. Decreased triglycerides and cholesterol
Correct Answer: B
Rationale: Beta1-selective blockers (e.g., atenolol) have less impact on insulin release compared to non-selective blockers.
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Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:
- A. Notify your health-care provider immediately if you have visual change.
- B. Monitor your own blood pressure and pulse daily.
- C. Take a hot shower or bath if you feel dizzy.
- D. Use a sunscreen on exposed body surfaces.
Correct Answer: C
Rationale: Hot showers can worsen amiodarone-induced hypotension, not help it.
The home health nurse is caring for a 77-year-old patient with congestive heart failure. What would the nurse consider a priority to assess to develop the most effective plan of care related to medication administration?
- A. Description of the patient's living environment
- B. Required lifestyle changes
- C. Family members in the community
- D. Compliance with therapy to reduce risk of skin breakdown
Correct Answer: A
Rationale: Living environment affects medication storage, access, and administration, critical for an elderly patient with CHF.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
Pernicious anemia is treated with:
- A. Folic acid supplements
- B. Thiamine supplements
- C. Vitamin B12
- D. Iron
Correct Answer: C
Rationale: Pernicious anemia requires B12 due to absorption defect; folate masks it without fixing neuropathy.
Drugs significantly affected by enzyme induction include the following except:
- A. Barbiturate
- B. Chlorpromazine
- C. Diphenyl hydantoin
- D. Warfarin
Correct Answer: B
Rationale: Barbiturates, phenytoin (diphenyl hydantoin), and warfarin are affected by enzyme induction; chlorpromazine is less so.