The parents of a 2-month-old infant ask the primary care nurse practitioner (NP) if they can immunize their child by giving one or two immunizations per month instead of following the recommended immunization schedule for vaccines at 2, 4, 6, 12, and 15 months of age. The NP should:

Correct Answer: C

Rationale: The correct answer is C because delaying vaccines postpones protection, critical for vulnerable infants. Choice A is incorrect (safety trumps preference). Choice B is wrong (longer intervals don’t reduce antibodies). Choice D is inaccurate (restart not usually required).

Correct Answer: D

Rationale: Choice D is correct because prior substance abuse, young age (impulsivity), and mental health issues (self-medication) are all established risk factors for misuse, per addiction research. Choice A is incorrect alone as it's one factor. Choice B is wrong by itself because age is just part. Choice C is incorrect solo since mental health is only one aspect.

Correct Answer: A

Rationale: Choice A is correct because ginkgo biloba has antiplatelet effects, enhancing warfarin's anticoagulation and bleeding risk, so it should be avoided. Choice B is incorrect as echinacea doesn't significantly interact with warfarin. Choice C is wrong because valerian root's sedative effects don't notably affect anticoagulation. Choice D is incorrect since only ginkgo biloba poses a clear risk.

Correct Answer: A

Rationale: When taking alendronate, it is important to take the medication with a full glass of water to prevent esophageal irritation. This helps ensure that the medication reaches the stomach and is properly absorbed. Lying down after taking alendronate can increase the risk of esophageal irritation, which is why it is recommended to stay upright for at least 30 minutes after taking the medication. Taking the medication at bedtime or avoiding dairy products are not specific instructions associated with alendronate administration. Therefore, the correct instruction to include is to take the medication with a full glass of water.

Correct Answer: B

Rationale: The correct answer is B because naproxen, highly protein-bound, can become toxic with low albumin from malnutrition, as seen in this patient’s weight loss. Choice A is incorrect as quinidine isn’t primarily protein-bound related. Choice C is wrong since calcium citrate isn’t affected this way. Choice D is inaccurate as calcium channel blockers have different concerns.

Correct Answer: B

Rationale: Choice B is correct because excretion is the process by which the body eliminates a drug, primarily via the kidneys, completing its removal from the system. Choice A is incorrect as distribution moves the drug within the body, not out of it. Choice C is wrong because absorption brings the drug into the bloodstream, not clears it. Choice D is incorrect since metabolism transforms the drug, but excretion removes it.

Correct Answer: A

Rationale: Choice A is correct because a loading dose, like azithromycin's higher first-day dose, quickly elevates drug levels to the therapeutic range for faster effect. Choice B is incorrect as steady state, not loading, takes four to five half-lives; loading bypasses this delay. Choice C is wrong because renal function affects maintenance dosing, not the loading concept. Choice D is incorrect since circulation to tissues is a distribution issue, not the purpose of a loading dose.

Correct Answer: D

Rationale: Choice D is correct because increasing doses (short-term fix), switching drugs (new mechanism), and drug holidays (reset sensitivity) all manage tolerance, per clinical strategies. Choice A is incorrect alone as it's one method. Choice B is wrong by itself because switching is just part. Choice C is incorrect solo since holidays are only one option.

Correct Answer: A

Rationale: Choice A is correct because acetaminophen is safe and widely used in children for pain and fever, with a favorable safety profile per pediatric guidelines. Choice B is incorrect as aspirin is avoided in children due to Reye's syndrome risk. Choice C is wrong because codeine's variable metabolism (CYP2D6) can cause respiratory depression, leading to restrictions in kids. Choice D is incorrect since only acetaminophen is broadly safe.