A woman who is pregnant and is planning to breastfeed tells the primary care NP that she has never had chickenpox. The NP should:

Correct Answer: C

Rationale: The correct answer is C because live vaccines like Varivax are contraindicated in pregnancy but safe post-delivery during breastfeeding. Choice A is incorrect (pregnancy risk). Choice B is wrong (globulin not for prevention). Choice D is inaccurate (delaying unnecessary).

Correct Answer: D

Rationale: Choice D is correct because off-label use lacks FDA approval (unregulated indication), risks ADRs (untested context), and may have limited evidence, per pharmacology concerns. Choice A is incorrect alone as it's one risk. Choice B is wrong by itself because ADRs are just part. Choice C is incorrect solo since evidence is only one issue.

Correct Answer: B

Rationale: Choice B is correct because St John's wort induces P-glycoprotein and CYP3A4, reducing digoxin levels and efficacy, a significant interaction. Choice A is incorrect as ginkgo biloba doesn't notably affect digoxin. Choice C is wrong because valerian root has minimal impact on digoxin pharmacokinetics. Choice D is incorrect since only St John's wort interacts markedly.

Correct Answer: B

Rationale: Choice B is correct because a peak level above the minimum toxic concentration indicates the drug concentration exceeds the safe therapeutic range, likely causing adverse effects. Choice A is incorrect as therapeutic effects occur below toxicity, not above. Choice C is wrong because shortening doses doesn't address an already toxic level; dose reduction is needed. Choice D is incorrect since duration isn't the issue—peak concentration is.

Correct Answer: A

Rationale: Choice A is correct because the Institute of Medicine recommends transparency in conflicts of interest to reduce bias in prescribing education, promoting objectivity. Choice B is incorrect as banning reps isn't a universal recommendation—disclosure is preferred. Choice C is wrong because samples aren't tied to insurance status in this context. Choice D is incorrect since even low-value gifts can influence, and disclosure is the broader solution.

Correct Answer: B

Rationale: Choice B is correct because Schedule III drugs (e.g., anabolic steroids) have moderate abuse potential, less than Schedule II, with medical use, per DEA. Choice A is incorrect as high potential is Schedule II. Choice C is wrong because low potential is Schedule IV. Choice D is incorrect since only B applies.

Correct Answer: A

Rationale: The correct answer is A because nonlinear kinetics means unpredictable elimination, requiring close monitoring due to a narrow therapeutic window. Choice B is incorrect as a high loading dose risks toxicity. Choice C is wrong since creatinine monitoring isn’t specific to nonlinear kinetics. Choice D is inaccurate as route doesn’t address kinetics.

Correct Answer: B

Rationale: Choice B is correct because acetaminophen is safe for breastfeeding, with low milk levels and no significant infant effects, per AAP guidelines. Choice A is incorrect as fluoxetine's milk transfer risks infant exposure. Choice C is wrong because isotretinoin isn't safe—it's contraindicated in breastfeeding due to toxicity. Choice D is incorrect since only acetaminophen is safe.

Correct Answer: C

Rationale: Choice C is correct because isotretinoin (Category X) causes severe birth defects and is avoided in pregnancy unless benefits (e.g., life-saving) outweigh risks, unlike others. Choice A is incorrect as fluoxetine (Category C) is often used if benefits justify it, with less severe risk. Choice B is wrong because acetaminophen (Category B) is generally safe in pregnancy. Choice D is incorrect since only isotretinoin fits the strict avoidance criterion.