When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?

Correct Answer: D

Rationale: The correct answer is D, the 78-year-old patient who is to have gallbladder removal. Older adults have a higher risk of altered response to anesthesia due to age-related changes in organ function, decreased metabolism, and increased sensitivity to medications. The other choices are less likely to have altered responses: A is young and healthy, B has stopped smoking which can reduce anesthesia risks, and C is a young patient with a routine procedure. Overall, age and complexity of the surgical procedure are key factors in determining the risk of altered response to anesthesia.

Correct Answer: B

Rationale: The correct answer is B: the patient’s warfarin dose is at therapeutic levels. An INR level of 2.5 is within the target range for patients on anticoagulant therapy, indicating that the warfarin dose is effective in preventing clot formation. A: Incorrect. An INR of 2.5 is considered therapeutic, so the patient is receiving enough warfarin. C: Incorrect. INR does not reflect heparin levels, so the intravenous heparin dose cannot be determined from this value. D: Incorrect. Similar to choice C, INR does not reflect heparin levels, so the status of the intravenous heparin dose cannot be determined.

Correct Answer: C

Rationale: The correct answer is C: Oral contraceptives are less effective while the patient is taking rifampin. Rifampin induces hepatic enzymes, which can accelerate the metabolism of oral contraceptives, leading to decreased contraceptive efficacy. This can result in breakthrough bleeding and potential contraceptive failure. It is important to advise the patient to use additional non-hormonal contraceptive methods while on rifampin therapy to prevent unintended pregnancy. Incorrect answer explanations: A: Women do not have a high risk for thrombophlebitis while on rifampin. Rifampin is not known to directly increase the risk of thrombophlebitis. B: A higher dose of rifampin is not necessary because of the contraceptive. Rifampin does not interact with oral contraceptives in a way that requires a higher dose. D: The incidence of adverse effects is not necessarily greater if the two drugs are taken together. Adverse effects are more related to individual drug reactions rather than a

Correct Answer: C

Rationale: Conjugation involves attaching a molecule to a drug to increase its solubility for elimination. Hydrolysis is not a conjugation process but rather a breakdown of molecules by water. Glucuronidation, sulfation, and methylation are all types of conjugation reactions. Glucuronidation adds a glucuronic acid, sulfation adds a sulfate group, and methylation adds a methyl group to the drug. So, C is the correct answer as it does not involve drug conjugation.

Correct Answer: D

Rationale: The correct answer is D because most local anesthetic agents consist of all three components: a lipophilic group (often an aromatic ring) for membrane penetration, an intermediate chain (usually containing an ester or amide) for linkage to the lipophilic group, and an amino group for interaction with the sodium channels. A is correct as the lipophilic group aids in crossing the lipid-rich cell membrane. B is correct as the intermediate chain connects the lipophilic group and amino group. C is correct as the amino group interacts with sodium channels to block nerve conduction. Therefore, all three components are essential for the local anesthetic mechanism of action.