Which of the following drugs is more likely to cause hyperkalaemia than hypokalaemia in a patient with diabetes and estimated glomerular filtration rate (eGFR) within the 'normal' reference range?

Correct Answer: D

Rationale: Hyperkalemia involves elevated potassium, hypokalemia reduced levels. Amphotericin causes hypokalemia via renal potassium wasting, not hyperkalemia. Prednisolone, a glucocorticoid, promotes potassium excretion, risking hypokalemia. Low molecular weight heparin (LMWH) rarely affects potassium directly with normal eGFR. Salmeterol, a beta-agonist, can shift potassium intracellularly, causing hypokalemia. Insulin, in diabetes management, drives potassium into cells with glucose, potentially causing hyperkalemia if renal excretion is impaired, though less common with normal eGFR. However, its potassium-shifting effect makes hyperkalemia more likely than hypokalemia compared to others, especially in acute settings, a key consideration in diabetic care.

Correct Answer: C

Rationale: A comprehensive drug history includes information about the patient's current and past medication use, including over-the-counter drugs, herbal supplements, and non-pharmacological pain relief methods. Asking, 'When you have pain, what do you do to relieve it?' provides insight into the patient's self-management strategies and helps identify potential drug interactions or misuse. While questions about sleeping pills, family history, and childhood diseases are relevant, they do not provide as much information about the patient's current medication practices. Therefore, focusing on pain relief methods is the most effective way to gather a detailed drug history.

Correct Answer: D

Rationale: Hyperkalemia involves elevated potassium, hypokalemia reduced levels. Amphotericin causes hypokalemia via renal potassium wasting, not hyperkalemia. Prednisolone, a glucocorticoid, promotes potassium excretion, risking hypokalemia. Low molecular weight heparin (LMWH) rarely affects potassium directly with normal eGFR. Salmeterol, a beta-agonist, can shift potassium intracellularly, causing hypokalemia. Insulin, in diabetes management, drives potassium into cells with glucose, potentially causing hyperkalemia if renal excretion is impaired, though less common with normal eGFR. However, its potassium-shifting effect makes hyperkalemia more likely than hypokalemia compared to others, especially in acute settings, a key consideration in diabetic care.

Correct Answer: C

Rationale: Rickets, from vitamin D deficiency, improves with sunlight-20 minutes boosts D synthesis, per physiology-plus supplements. Dairy aids calcium, not avoided. Brand vs. generic is irrelevant-efficacy equals. Empty stomach isn't needed-fat aids absorption. Sunlight complements, per treatment.

Correct Answer: D

Rationale: The correct statement is that the colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. Bile acid sequestrants like colestipol can bind to other medications, reducing their absorption and effectiveness. Therefore, they should be taken separately from other medications to prevent any interactions. Additionally, colestipol should ideally be administered with meals to improve tolerability and adherence, although this was not one of the options given in the question.

Correct Answer: B

Rationale: An international normalized ratio (INR) level of 3 indicates that the patient's warfarin dose is within the therapeutic range for anticoagulation. In patients with mechanical heart valves, the target INR range is usually higher (around 2.5 to 3.5) to prevent thrombus formation on the prosthetic valve. An INR of 3 demonstrates that the anticoagulant effect of warfarin is at an appropriate level to reduce the risk of blood clots while minimizing the risk of bleeding complications. If the INR level was subtherapeutic (below the target range), it would indicate that the patient is not receiving enough warfarin to achieve the desired anticoagulant effect.

Correct Answer: D

Rationale: Aspirin on an empty stomach absorbs fastest, speeding headache relief by avoiding food delays-fatty meals like peanut butter slow gastric emptying, reducing onset. Alkaline foods may alter pH but don't hasten absorption significantly. Enteric-coated forms delay release for GI protection, not speed. Empty stomach delivery maximizes bioavailability quickly, aligning with pain relief urgency.

Correct Answer: A

Rationale: Oral decongestants (e.g., pseudoephedrine) act systemically, raising blood pressure via vasoconstriction, a key difference from nasal decongestants (e.g., oxymetazoline), which act locally but risk rebound congestion. The statement 'Oral decongestants can cause hypertension' shows the client grasps this systemic effect, indicating effective teaching. Nasal decongestants aren't safe for a month ; they cause rebound after 3-5 days. Only nasal decongestants typically cause rebound , not oral. Oral efficacy varies, not inherently superior. Choice A reflects accurate understanding of oral decongestants' broader impact, critical for safe use, making it the best learning indicator.

Correct Answer: C

Rationale: Fever and CO2 rise during surgery suggest malignant hyperthermia (MH). Dantrolene , a ryanodine receptor antagonist, halts MH by blocking calcium release. Acetaminophen reduces fever but not MH. Bromocriptine treats neuroleptic syndrome. Diazepam and Naproxen (E) are irrelevant. Dantrolene's specificity saves lives in this surgical emergency.