The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect?

Correct Answer: B

Rationale: Oral drugs face first-pass metabolism in the liver, reducing bioavailability, so higher doses are needed for therapeutic effect compared to IV (100% bioavailability), sublingual (bypasses liver), or rectal (partial bypass). Oral route's loss to metabolism drives dosage needs, a pharmacokinetic distinction.

Correct Answer: C

Rationale: In assessing the effectiveness of bisphosphonate therapy for osteoporosis, a bone density scan (Option C) is the best option. Bone density scans provide quantitative measurements of bone mineral density, which directly reflects the strength and density of bones. Improvements in bone density indicate the positive impact of the medication on bone health. Option A, normal serum calcium levels, is not the most reliable indicator of bisphosphonate effectiveness because calcium levels can be influenced by various factors other than bone density. Option B, absence of fractures, while important, may not necessarily reflect changes in bone density. Fracture occurrence can also be influenced by factors such as falls or trauma. Option D, absence of bone pain, is subjective and may not always correlate with improvements in bone density. Pain can be influenced by various factors beyond bone health. Educationally, understanding the rationale behind monitoring bone density in osteoporosis treatment is crucial for healthcare providers. It emphasizes the importance of using objective measures to assess treatment efficacy and highlights the significance of bone health in managing osteoporosis effectively. Regular bone density monitoring can help track progress, adjust treatment plans, and ultimately improve patient outcomes.

Correct Answer: A

Rationale: Fever and severe neutropenia (250 neutrophils/μL) in a schizophrenic patient suggest clozapine . Clozapine causes agranulocytosis, a rare but serious side effect requiring monitoring. Olanzapine , Quetiapine , Risperidone , and Haloperidol (E) rarely cause this. Clozapine's risk explains the acute presentation, necessitating immediate cessation.

Correct Answer: B

Rationale: The correct answer is B) Decreased risk of ectopic pregnancy. Oral contraceptives containing estrogen and progestin help prevent pregnancy primarily by inhibiting ovulation and thickening cervical mucus, making it difficult for sperm to reach the egg. By effectively preventing pregnancy, oral contraceptives significantly reduce the risk of ectopic pregnancies, which occur when a fertilized egg implants outside the uterus, often in the fallopian tubes, leading to serious complications. Option A, decreased risk of colon cancer, is not a direct benefit of oral contraceptives. In fact, some studies suggest a slight increase in the risk of certain cancers with long-term oral contraceptive use. Option C, decreased risk of infiltrating ductal carcinoma of the breast, is not a primary benefit of oral contraceptives. While there is some evidence linking hormonal contraceptives to a slight increase in breast cancer risk, especially with long-term use, the association is complex and not as straightforward as the benefits for preventing ectopic pregnancies. Option D, decreased risk of medullary carcinoma of the thyroid, is not a known benefit of oral contraceptives. The primary focus of oral contraceptives is on preventing pregnancy and not specifically related to thyroid cancer prevention. In an educational context, understanding the mechanisms of action and benefits of oral contraceptives is crucial for healthcare providers to counsel patients effectively on their use. It is essential for students and practitioners to grasp the primary indications and effects of oral contraceptives to provide accurate information and support patient decision-making regarding contraception methods.

Correct Answer: C

Rationale: In this scenario, the most likely explanation for the patient's symptoms of acute abdominal pain, inability to pass flatus or bowel movement after being prescribed Ditropan for urinary frequency while on amitriptyline is paralytic ileus (Option C). Paralytic ileus is a condition characterized by the temporary cessation of bowel motility, which can be caused by certain medications like anticholinergics such as Ditropan. Option A, alcoholic hepatitis, is less likely in this case as the patient's symptoms are more indicative of a gastrointestinal issue rather than liver inflammation. Option B, pancreatitis, is also less likely as the symptoms presented are more consistent with a bowel motility issue rather than pancreatic inflammation. Option D, a supratherapeutic dose of medication, is not the most likely explanation as the symptoms are more in line with a side effect of the medication rather than an overdose. Educationally, this case highlights the importance of recognizing potential adverse effects and drug interactions when managing patients on multiple medications. Understanding the mechanisms of action and side effect profiles of medications is crucial in providing safe and effective patient care. It also underscores the need for thorough patient assessment and monitoring to promptly identify and address any complications that may arise during pharmacological management.