Which of the following drugs given chronically would be most likely to contribute to a decreased risk of further stroke in the patient?

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: 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.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Lidocaine. Lidocaine is a class IB anti-arrhythmic drug commonly used to treat ventricular arrhythmias. It works by blocking sodium channels in the heart, thus stabilizing cell membranes and reducing abnormal electrical activity. Option B) Procainamide is a class IA anti-arrhythmic drug, not class IB like lidocaine. Procainamide works by slowing conduction in the heart and prolonging the action potential duration. Option C) Mexiletine is also a class IB anti-arrhythmic drug, similar to lidocaine. However, in this case, lidocaine is a more common and widely recognized class IB anti-arrhythmic drug. Option D) Metoprolol is a beta-blocker, which is not classified as a class IB anti-arrhythmic drug. Beta-blockers work by blocking the effects of adrenaline on the heart, reducing heart rate and blood pressure. Understanding the classification of anti-arrhythmic drugs is crucial for nursing students preparing for the NCLEX exam. Knowing the specific characteristics and mechanisms of action of each class helps in selecting the appropriate drug for a given arrhythmia scenario. It is essential to differentiate between the various classes to ensure safe and effective medication administration in clinical practice.

Correct Answer: B

Rationale: The correct answer is B) It must be taken at least 2 hours before and 4 hours after a bile acid sequestrant. This is because Zetia (exetimibe) can bind to bile acid sequestrants in the intestine, which can reduce the absorption of Zetia. Therefore, to ensure optimal absorption and effectiveness of Zetia, it should be taken separately from bile acid sequestrants. Option A) It must be taken with food - This is incorrect as Zetia can be taken with or without food. Option C) It cannot be taken with milk - This is incorrect as Zetia can be taken with milk or other dairy products. Option D) It cannot be taken with a statin drug - This is incorrect as Zetia can be taken with a statin drug. In fact, Zetia is often prescribed in combination with a statin to help lower cholesterol levels more effectively. Educationally, it is important for nurses to understand the specific medication instructions for Zetia to ensure its optimal therapeutic effects. By educating clients on the appropriate timing of taking Zetia in relation to other medications like bile acid sequestrants, nurses can help prevent drug interactions and ensure the best outcomes for the patient's cardiovascular health.