Nokea
Which route of drug administration is most likely to lead to first pass effect?
- A. Sublingual
- B. Oral
- C. Intravenous
- D. Intramuscular
Correct Answer: B
Rationale: Oral administration subjects drugs to the first-pass effect, where they are metabolized by the liver via the portal vein before reaching systemic circulation, reducing bioavailability.
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The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she can know whether a medication is safe to take while pregnant. What is the nurses best response?
- A. You can take any drug indicated as a Category A.
- B. No medications should be taken during pregnancy.
- C. Never take medication until you receive approval from your health care provider.
- D. Most medications are safe but you need to weigh benefit against risk.
Correct Answer: C
Rationale: The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While Category A drugs have no known risk, they may be contraindicated by the woman's health condition or pregnancy issues and many pregnant women would not know what it means to be a Category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.
A patient has been using sleeping pills every night for the past several months. Now admitted to the hospital, he is prescribed his usual dose of sleeping pill. After administration, the patient continues to be restless and is wide awake. The nurse notifies the health care provider, who prescribes an increased dose. After receiving the new dose, the patient falls asleep. The nurse interprets this as which of the following?
- A. Drug idiosyncrasy
- B. Cumulative drug effect
- C. Drug tolerance
- D. Toxic reactions
Correct Answer: C
Rationale: The patient has developed drug tolerance and has to be administered an increased dosage of the drug to achieve the desired effect. Cumulative drug effect occurs when the body is unable to metabolize and excrete one (normal) dose of a drug before the next dose is given. Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. Toxic reactions are caused when blood concentration levels exceed the therapeutic levels of a drug.
A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient?
- A. Blood urea nitrogen (BUN) and creatinine
- B. Electrolytes
- C. Fluconazole levels
- D. Glucose
Correct Answer: D
Rationale: Fluconazole inhibits CYP450, increasing sulfonylurea levels and hypoglycemia risk; glucose monitoring is key. Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.
Pregnant women should receive the Tdap vaccine:
- A. In the first trimester
- B. Once every 10 years
- C. In the third trimester of every pregnancy
- D. Tdap is contraindicated in pregnancy
Correct Answer: C
Rationale: Tdap in the third trimester protects newborns from pertussis; it's not contraindicated or trimester-specific otherwise.
Glucocorticoids enhance:
- A. Inhibition of phospholipase A2 in leukocytes with stimulation of annexin synthesis
- B. Decrease of thrombocyte activating factor via inhibition of 5 lipooxigenase
- C. Inhibition of leukotriene synthesis and decrease of lyso-glycerilphosphorilcholine production
- D. inhibition of prostaglandin synthesis via blocking 12 lypooxigenase
Correct Answer: A
Rationale: Glucocorticoids inhibit phospholipase A2, reducing inflammatory mediators by stimulating annexin (lipocortin) synthesis.