Tick the unwanted effects of intravenous acyclovir infusion:

Correct Answer: A

Rationale: The correct answer is A because intravenous acyclovir can cause renal insufficiency due to its nephrotoxic effects. Tremors and delirium are not typically associated with acyclovir. Choice B includes common side effects like rash, diarrhea, and nausea that are not considered unwanted effects. Choice C includes neuropathy and abdominal pain, which are not common unwanted effects of acyclovir infusion. Choice D includes anemia, neutropenia, nausea, and insomnia, which are not typically associated with acyclovir infusion.

Correct Answer: C

Rationale: The correct answer is C: Lovastatin. Lovastatin is a statin drug that helps lower cholesterol levels, reducing the risk of atherosclerosis and subsequent stroke. It has been shown to decrease the risk of future stroke events. Isosorbide mononitrate (A) is a vasodilator used for angina, not stroke prevention. Furosemide (B) is a diuretic used for heart failure and hypertension, not for stroke prevention. Esmolol (D) is a beta-blocker used for heart rate control, not for stroke prevention.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Myopathy. When a patient is prescribed a combination of niacin and atorvastatin to manage hypercholesterolemia, they are at an increased risk of developing myopathy, which is a known adverse effect of statin medications like atorvastatin. Myopathy presents as muscle pain, weakness, or tenderness, and can progress to severe complications like rhabdomyolysis. Option A) Agranulocytosis is not typically associated with niacin or atorvastatin therapy. Agranulocytosis is a condition characterized by a dangerously low white blood cell count. Option B) Gallstones are not a common side effect of niacin or atorvastatin therapy. Gallstones are more commonly associated with rapid weight loss or high cholesterol levels. Option C) Lactic acidosis is a rare but serious side effect of some medications like metformin, but it is not typically associated with niacin or atorvastatin. Educationally, understanding the potential side effects of cardiovascular medications is crucial for nurses and healthcare providers to ensure patient safety and optimal outcomes. Monitoring for signs and symptoms of myopathy in patients on niacin and atorvastatin can help in early detection and management of this adverse effect, preventing serious complications.

Correct Answer: C

Rationale: In this NCLEX practice question, the correct answer is C) Isosorbide mononitrate because it undergoes minimal first-pass metabolism in the liver. Isosorbide mononitrate is a prodrug that is converted to its active form, isosorbide-5-mononitrate, primarily in the blood and tissues rather than in the liver. This characteristic allows for a greater bioavailability of the active drug compared to other organic nitrates. Option A) Glyceryl trinitrate, option B) Isosorbide dinitrate, and option D) Erythrityl tetranitrate undergo significant first-pass metabolism in the liver, leading to a lower bioavailability of the active drug. Glyceryl trinitrate and Isosorbide dinitrate are metabolized by the liver, while Erythrityl tetranitrate undergoes extensive first-pass metabolism, resulting in reduced efficacy of the drug. In an educational context, understanding the metabolic pathways of cardiovascular drugs is crucial for nursing students preparing for the NCLEX exam. Knowledge of which drugs undergo minimal first-pass metabolism can impact dosing strategies, drug effectiveness, and potential side effects. This question reinforces the importance of pharmacokinetics in drug therapy and highlights the significance of selecting the most appropriate medication based on its metabolism profile.

Correct Answer: B

Rationale: The correct answer is B) Its total initial oral and parenteral digitalization dose is the same. Digitoxin, a cardiac glycoside, is primarily administered orally due to its high bioavailability. The oral and parenteral routes have equivalent efficacy in achieving therapeutic levels, making parenteral administration unnecessary. This is important to ensure patient comfort and compliance, as well as reducing the risk of adverse effects associated with parenteral administration. Option A is incorrect because the rationale for not giving digitoxin parenterally is not related to pain. Option C is incorrect because digitoxin is not quickly metabolized when given intravenously or intramuscularly. Option D is incorrect because while IV route may be preferred in certain situations, it is not the sole reason for not giving digitoxin parenterally. In an educational context, understanding the rationale behind drug administration routes is crucial for healthcare professionals to make informed decisions regarding patient care. By knowing the reasons why certain drugs are given through specific routes, healthcare providers can optimize treatment outcomes, minimize risks, and ensure patient safety and comfort. This knowledge is essential for passing exams like the NCLEX and for providing high-quality patient care in clinical practice.