A patient who is taking warfarin (Coumadin) therapy has a headache and calls the prescriber’s office to ask about taking a pain reliever. The nurse expects to receive instructions for which type of medication?

Correct Answer: C

Rationale: The correct answer is C: acetaminophen (Tylenol). Acetaminophen is the preferred pain reliever for patients on warfarin therapy because it does not interfere with the blood-thinning effects of warfarin. Aspirin, ibuprofen, and opioids can increase the risk of bleeding when taken with warfarin due to their antiplatelet or anti-inflammatory effects. Acetaminophen provides effective pain relief without affecting the anticoagulant properties of warfarin, making it the safest choice for this patient.

Correct Answer: A

Rationale: The correct answer is A: Acetylation. In the second phase of biotransformation, conjugation reactions occur where a functional group is added to the drug molecule. Acetylation involves the addition of an acetyl group to the drug molecule, making it more water-soluble and easier to excrete. Reduction (B) typically occurs in the first phase, oxidation (C) can occur in both phases, and hydrolysis (D) usually occurs in the first phase as well. Therefore, acetylation is the most likely process to proceed in the second phase of biotransformation.

Correct Answer: A

Rationale: The correct answer is A because a good local anesthetic agent should not cause local irritation and tissue damage. Local anesthetics work by blocking nerve signals in a specific area, without causing harm to surrounding tissues. Choices B, C, and D are incorrect because systemic toxicity, fast onset, and long duration of action, and vasodilatation are all aspects that can be associated with local anesthetics but are not necessarily indicative of a poor local anesthetic agent.

Correct Answer: C

Rationale: Nicotine is the correct answer because it activates both muscarinic and nicotinic receptors. Nicotinic receptors are ligand-gated ion channels found at neuromuscular junctions and autonomic ganglia. Muscarinic receptors are G-protein coupled receptors found in various tissues. Lobeline primarily acts on nicotinic receptors, pilocarpine primarily acts on muscarinic receptors, and bethanechol primarily acts on muscarinic receptors. Therefore, nicotine is the only cholinomimetic that activates both receptor types.

Correct Answer: B

Rationale: Step-by-step rationale for why B (Atropine) is the correct answer: 1. Scopolamine is an anticholinergic drug, similar to Atropine. 2. Both drugs block the action of acetylcholine at muscarinic receptors. 3. They are used for similar indications like treating motion sickness. 4. Hexamethonium is a ganglionic blocker, Succinylcholine is a depolarizing muscle relaxant, and Pilocarpine is a muscarinic agonist, making them unrelated to scopolamine's pharmacologic actions.