A 27-year-old female with vulvovaginal candidiasis is given a one-time 100 mg dose of oral fluconazole. Administration of the medication results in a peak plasma concentration of 20 mg/L. What is the apparent volume of drug distribution?

Correct Answer: D

Rationale: The correct answer is D) 5 L. Rationale: The apparent volume of distribution (Vd) is a pharmacokinetic parameter that describes the extent of drug distribution in the body. It is calculated by dividing the total amount of drug in the body by the plasma drug concentration. In this case, the peak plasma concentration of fluconazole is 20 mg/L and the dose given is 100 mg. Therefore, Vd = Dose / Cmax = 100 mg / 20 mg/L = 5 L. Explanation of other options: A) 0.5 L - This option is incorrect because the Vd calculated based on the information provided is 5 L, not 0.5 L. B) 1 L - This option is incorrect because the Vd calculated based on the information provided is 5 L, not 1 L. C) 3 L - This option is incorrect because the Vd calculated based on the information provided is 5 L, not 3 L. Educational context: Understanding pharmacokinetic parameters like volume of distribution is crucial in pharmacology as it helps in determining the appropriate dosing regimens for drugs. A higher volume of distribution indicates that the drug is distributed extensively in tissues outside the bloodstream, which can impact dosing frequency and duration of therapy. This knowledge is essential for healthcare professionals to optimize drug therapy and ensure patient safety and efficacy.

Correct Answer: D

Rationale: The correct answer is D) The proportion eliminated remains constant over time. In first-order kinetics, the elimination of a drug occurs at a rate that is proportional to the drug's concentration in the body. This means that a constant fraction of the drug is eliminated per unit of time, regardless of the drug's concentration. As a result, the proportion eliminated remains constant over time, leading to a predictable and consistent rate of drug clearance. Option A) It follows a linear pattern is incorrect because first-order kinetics do not necessarily imply a linear relationship between drug concentration and elimination rate. Instead, the elimination rate is proportional to the drug concentration. Option B) Elimination is constant regardless of concentration is incorrect because in first-order kinetics, the elimination rate is dependent on the drug's concentration. It is not a constant value but a constant fraction of the drug present in the body at any given time. Option C) Clearance changes with dose is incorrect because drug clearance, in the context of first-order kinetics, is not directly related to the dose administered. Clearance is determined by the drug's characteristics and the body's ability to eliminate it, independent of the dose given. Understanding the principles of drug elimination kinetics is crucial for healthcare professionals to predict drug behavior, adjust dosages, and ensure optimal therapeutic outcomes for patients. This knowledge is essential in pharmacology and clinical practice to make informed decisions regarding drug administration and monitoring.

Correct Answer: B

Rationale: In this scenario, option B is the correct choice. When a patient with severe preeclampsia is on magnesium sulfate and the level reaches 7 mEq/L, it is crucial to contact the healthcare provider and report the level. This is because a magnesium level of 7 mEq/L is above the therapeutic range, increasing the risk of magnesium toxicity. Option A is incorrect because a level of 7 mEq/L is not within the therapeutic range, so simply monitoring the patient would be inadequate. Option C is incorrect as administering calcium gluconate is not the initial action for high magnesium levels; it is used to counteract the effects of magnesium toxicity. Option D is also incorrect as turning the patient and administering oxygen are not appropriate interventions for high magnesium levels. In an educational context, understanding the implications of magnesium sulfate levels in patients with preeclampsia is essential for nurses caring for these individuals. Recognizing the signs of magnesium toxicity and knowing the appropriate actions to take can prevent serious complications. This question highlights the importance of prompt communication with healthcare providers when abnormal lab values are identified, emphasizing the critical role of nursing assessment and intervention in ensuring patient safety.

Correct Answer: C

Rationale: The correct answer is option C: "Some women may begin a brisk walking program to precipitate labor." This response is appropriate because engaging in physical activity like brisk walking can help stimulate contractions and potentially kickstart the labor process naturally. It is a non-invasive method that some women find helpful in initiating labor without the need for medical interventions. Option A is incorrect because there are indeed natural methods, like physical activity, that can help start labor. Option B is incorrect as it discusses the use of amniocentesis to assess lung maturity, which is not directly related to starting labor. Option D is incorrect as it focuses on medical interventions to induce labor rather than non-pharmacological methods. In an educational context, it is essential for nurses to be aware of non-pharmacological ways to support women in labor. Educating clients on safe and effective methods to help start labor can empower them to be active participants in their birthing process. Additionally, understanding the limitations and risks of various interventions is crucial for providing evidence-based and patient-centered care.

Correct Answer: A

Rationale: In the scenario of a 33-year-old client experiencing 'back labor' during active labor, the most effective nursing intervention would be option A) Counterpressure against the sacrum. This technique involves applying firm pressure on the sacrum to alleviate the intense lower back pain commonly experienced during back labor. Counterpressure against the sacrum helps relieve the pressure on the lower back by stabilizing and supporting the sacrum, thereby reducing the discomfort associated with back labor. This technique is particularly effective as it targets the specific area of pain and provides physical support to the client during labor. Regarding why the other options are less effective: - Option B) Pant-blow breathing techniques may help manage pain and provide relaxation but may not directly address the intense lower back pain experienced during back labor. - Option C) Effleurage, a light stroking massage technique, may offer some comfort but may not provide the necessary pressure and support to alleviate the specific lower back pain in back labor. - Option D) Conscious relaxation or guided imagery can be beneficial for pain management in labor, but in the case of intense lower back pain like back labor, direct physical interventions like counterpressure against the sacrum are more effective. In an educational context, it is crucial for nursing students to understand the various techniques available to manage labor pain effectively. By learning about specific interventions like counterpressure against the sacrum for back labor, students can develop comprehensive skills to support clients during childbirth and enhance their overall nursing care delivery in obstetric settings.