A patient is undergoing major surgery and asks the nurse about a living will. He states, 'I don't want anybody making decisions for me. And I don't want to prolong my life.' The patient is demonstrating

Correct Answer: A

Rationale: Autonomy refers to the patient's right to make informed decisions about their own healthcare. By expressing a desire to avoid life-prolonging measures and requesting a living will, the patient is exercising his autonomy. Beneficence involves acting in the patient's best interest, justice refers to fairness in healthcare, and veracity involves truth-telling. The patient's statements align most closely with the principle of autonomy, as he is asserting his right to control his medical care.

Correct Answer: A

Rationale: Metoclopramide, a D2 antagonist, causes acute dystonia (e.g., oculogyric crisis). Procyclidine, an anticholinergic, rapidly reverses this IV, relaxing muscles, a suitable treatment. Benzhexol (trihexyphenidyl) works orally but is slower. Levodopa and bromocriptine, dopamine agonists, treat Parkinson's, not dystonia from dopamine blockade. Risperidone worsens it. IV procyclidine's speed is critical in acute settings, restoring normal movement effectively.

Correct Answer: D

Rationale: Dobutamine, a β1-selective agonist, can cause arrhythmias, so no arrhythmogenic effect is false. It increases myocardial oxygen consumption by enhancing contractility, not decreases it. It's selective, not non-selective, targeting cardiac β1 receptors. It doesn't act on CNS D2 dopamine receptors but on peripheral β1. It's used in heart failure to boost cardiac output, a true statement, making it valuable in acute settings. This inotropic effect distinguishes it from non-selective agents, critical for managing cardiogenic shock.

Correct Answer: D

Rationale: Calcium absorption in the small intestine relies heavily on vitamin D, which enhances the process by increasing the expression of calcium-binding proteins and improving gut uptake efficiency. Without adequate vitamin D, calcium absorption drops significantly, leading to potential bone health issues like osteoporosis or osteomalacia. Intrinsic factor, produced in the stomach, is critical for vitamin B12 absorption, not calcium, as it binds B12 for uptake in the ileum. Coenzymes, while involved in metabolic reactions, don't directly facilitate calcium absorption; their role is broader and unrelated to this specific process. Phosphorus, an abundant mineral, works with calcium in bone formation but doesn't enhance its absorption-in fact, excessive phosphorus can compete with calcium. Vitamin D's active form, calcitriol, regulates calcium levels by promoting its transport across intestinal cells, making it indispensable for maintaining skeletal integrity. This mechanism underscores why vitamin D deficiency impairs calcium utilization, distinguishing it from the other options, which lack a direct link to absorption efficiency.

Correct Answer: B

Rationale: Biliary secretion (e.g., rifampin) leads to fecal excretion for some drugs, while others recycle enterohepatically, prolonging action. Not all are fecal-bound-recirculation varies. Gallbladder stores bile, not metabolizes. Many drugs use bile, not rare. Recirculation reflects pharmacokinetics, affecting duration.