The following are schedule II drugs, except :

Correct Answer: B

Rationale: Schedule II drugs have a high potential for abuse and dependency but also have accepted medical uses. A, C, D, and E are all classified as schedule II drugs. However, heroin is not a schedule II drug; it is classified as a schedule I drug due to its extremely high potential for abuse and lack of accepted medical use in the United States.

Correct Answer: D

Rationale: A patient with a creatinine clearance of 20 mL/min indicates impaired kidney function or renal insufficiency. Loop diuretics are the preferred choice for patients with reduced kidney function because they act on the loop of Henle in the nephron, which is independent of creatinine clearance. They are effective for rapid diuresis even in patients with significantly reduced renal function. Loop diuretics, such as furosemide, are commonly used in patients with acute or chronic kidney disease to promote diuresis and manage fluid overload. Thiazides are not as effective in patients with low glomerular filtration rates, and osmotic diuretics may not be appropriate for rapid diuresis in this scenario. Potassium-sparing diuretics are not typically used for rapid diuresis but rather for maintaining potassium balance in cases where patients are at risk for hypokalemia.

Correct Answer: D

Rationale: Infants have a higher percentage of total body water (approximately 75%) compared to adults. This difference affects the distribution and concentration of water-soluble drugs, often requiring adjustments in dosing to achieve therapeutic effects. Increased protein in circulation, lower fat composition, and more muscular body composition are not primary factors influencing drug therapy in infants. Therefore, the nurse must consider the higher water composition when calculating drug dosages for pediatric patients.

Correct Answer: C

Rationale: Metformin belongs to the pharmacological class known as biguanides. Biguanides are a group of oral medications commonly used to treat type 2 diabetes by lowering blood sugar levels. Metformin works primarily by decreasing the production of glucose in the liver while also increasing the sensitivity of muscle cells to insulin. This class of drugs does not stimulate insulin release from the pancreas like sulfonylureas and meglitinides but rather works by targeting the liver and improving insulin sensitivity in peripheral tissues. The main pharmacological effect of metformin is to reduce hepatic glucose output, which helps to control blood glucose levels in individuals with type 2 diabetes.

Correct Answer: A

Rationale: The patient's symptoms of irregular pulse and leg weakness, along with high ileostomy output, suggest hypokalemia. High ileostomy output can lead to excessive loss of potassium, a key electrolyte responsible for muscle and nerve function. Hypokalemia can cause muscle weakness and cardiac arrhythmias, which align with the patient's symptoms. Hyperkalemia (B) would typically cause muscle cramps and cardiac abnormalities like peaked T-waves, not weakness. Hyponatremia (C) and hypercalcemia (D) do not typically present with these specific symptoms.