Nokea
Which of the following avoids first pass effect of drugs
- A. Oral ingestion
- B. Rectal Suppository
- C. Intra venous injection
- D. Intra-arterial injection
Correct Answer: D
Rationale: Intra-arterial injection bypasses the liver, avoiding first-pass metabolism.
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The adverse events of biguanides are:
- A. Alkalosis
- B. Hypoxemia/acidosis
- C. Weight loss
- D. Anemia
Correct Answer: B
Rationale: Biguanides like metformin can cause lactic acidosis, a serious adverse effect related to impaired mitochondrial function.
Mary has a two-tiered prescription benefit plan, which means:
- A. She can receive differing levels of care based on whether she chooses an 'in-plan' provider or not.
- B. She is eligible for the new Medicare Part D 'donut hole' reduction of costs program.
- C. She pays a higher copay for brand-name drugs than for generic drugs.
- D. She must always choose to be treated with generic drugs first.
Correct Answer: C
Rationale: A two-tiered plan typically involves higher copays for brand-name drugs.
The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patient's system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours?
- A. 22 mcg
- B. 16.5 mcg
- C. 11 mcg
- D. 5.5 mcg
Correct Answer: C
Rationale: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.
While collecting a medication history, the patient admits to doubling the recommended dosage of an over-the-counter (OTC) medication, saying its harmless or they would require a prescription. What is the nurses best response?
- A. OTC drugs are serious medications and carry serious risks if not taken as directed.
- B. Taking medications like that is careless and you could kill yourself doing it.
- C. Sometimes you need to take more than the package directs to treat the symptoms.
- D. Did you notify your doctor of the increased dosage you were taking?
Correct Answer: A
Rationale: OTC drugs are no less a medication than prescription drugs and carry the same types of risks for overdosage and toxicity if directions are not followed. Although increasing the dosage is careless and dangerous, it is important to use the information as a teaching opportunity rather than scolding the patient. Agreeing with the patient or asking her if she talked to the doctor misses the teaching opportunity, which could be harmful for the patient.
A nurse is preparing a teaching plan for a female client who has Bipolar disorder and a new prescription for Carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select one that does not apply.)
- A. This medication can safely be taken during pregnancy.
- B. Eliminate grapefruit juice from your diet.
- C. You will need to have a complete blood count and carbamazepine levels drawn periodically.
- D. You'll your provider if you develop a rash.
Correct Answer: A
Rationale: Grapefruit juice interacts, blood counts monitor toxicity, rash signals reaction, and driving caution addresses sedation.