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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Which of the following regarding E max is correct?
- A. E max assumes that as long as you increase the concentration of the drug, there will be a higher effect of the drug
- B. E max is used to compare the potency of different drugs
- C. E max assumes that all receptors are occupied by the drug and no increase in response is observed if a higher concentration of drug is obtained
- D. All of the previous points are incorrect
Correct Answer: C
Rationale: Emax is the maximal effect when all receptors are occupied; further dose increases yield no additional effect.
Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?
- A. A 35-year-old woman with cervical cancer
- B. A 41-year-old man with kidney stones
- C. A 50-year-old man with cirrhosis of the liver
- D. A 62-year-old woman in acute renal failure
Correct Answer: C
Rationale: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.
A patient with a new onset of systolic ejection murmur should be assessed for which nutritional deficiency?
- A. Vitamin B12
- B. Vitamin C
- C. Folate
- D. Niacin
Correct Answer: A
Rationale: Vitamin B12 deficiency can lead to anemia, potentially causing a systolic murmur.
A 57-year-old man was recently diagnosed with Type-2 diabetes mellitus and placed on a medication. He began having myalgias and feeling sick and later developed respiratory distress, so he went to the hospital. His pH was 7.2, and he had elevated blood lactate levels. Which drug is likely causing his problem?
- A. Acarbose
- B. Glyburide
- C. Metformin
- D. Pioglitazone
Correct Answer: C
Rationale: Metformin is associated with lactic acidosis, presenting with low pH and high lactate, especially in overdose or renal impairment.
A nurse is caring for a patient taking multiple drugs and is concerned about a possible drug-drug interaction. What is the nurse's first and best means of avoiding this problem?
- A. Consult a drug guide.
- B. Call the pharmacist.
- C. Contact the provider.
- D. Ask another nurse.
Correct Answer: A
Rationale: Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drug-drug interactions. Sometimes problems can be avoided by staggering the administration of the drugs or adjusting their dosages. Consulting the pharmacist is not wrong, but it would not be the first action to take. The nurse holds responsibility for his or her own practice so asking a health care provider or another nurse is based on the assumption that that professional is knowledgeable about all drug-drug interactions, which is likely not the case.