Which patient is the best candidate to receive nesiritide therapy?

Correct Answer: D

Rationale: Nesiritide is a synthetic form of brain natriuretic peptide (BNP) that is used for the treatment of acutely decompensated heart failure (HF) in patients who have dyspnea at rest. It works by vasodilating veins and arteries, leading to decreased preload and afterload, thus improving the symptoms of HF such as dyspnea and edema. Nesiritide is typically reserved for patients who are hospitalized with acute decompensated HF and severe symptoms like dyspnea at rest. Patients needing initial treatment for HF or those with atrial fibrillation may not necessarily benefit from nesiritide therapy. Patients with reduced cardiac output may benefit from other therapies aimed at improving cardiac function rather than nesiritide alone.

Correct Answer: C

Rationale: Propranolol is the drug that undergoes extensive first-pass hepatic metabolism. First-pass metabolism refers to the metabolism of a drug by the liver before it enters the systemic circulation. In the case of propranolol, a significant portion of the drug is metabolized by the liver before reaching the systemic circulation, leading to reduced bioavailability. This is why propranolol is often given in higher doses to achieve the desired therapeutic effect. Heparin, insulin, nitroglycerine, and warfarin do not undergo significant first-pass metabolism by the liver.

Correct Answer: A

Rationale: Common side effects of iron supplements include constipation, upset stomach, and nausea. Iron supplements can cause gastrointestinal side effects such as constipation, upset stomach, and nausea. These side effects usually improve over time or can be managed by taking the supplement with food or adjusting the dosage. It is important to speak with a healthcare provider if these side effects persist or worsen.

Correct Answer: A

Rationale: When a patient is on Warfarin therapy, the two primary tests that need to be monitored are the Prothrombin Time (PT) and the International Normalized Ratio (INR). Warfarin works by inhibiting the activity of Vitamin K-dependent clotting factors, and both PT and INR are measures of the extrinsic pathway of coagulation, which is primarily affected by Warfarin. PT measures the time it takes for blood to clot, while INR is a standardized calculation based on the PT value to monitor the effectiveness and safety of Warfarin therapy. Monitoring these tests helps ensure that the patient's blood is not too thick (increased risk of clotting) or too thin (increased risk of bleeding) while on Warfarin.

Correct Answer: A

Rationale: Iron supplements are known to commonly cause gastrointestinal side effects, such as constipation, upset stomach, and nausea. Constipation is a common side effect of iron supplements due to the way iron can harden the stool and slow down bowel movements. Upset stomach and nausea can occur because iron supplements can irritate the stomach lining, leading to discomfort and feelings of queasiness. It is important for individuals taking iron supplements to be aware of these potential side effects and to speak with their healthcare provider if they are experiencing severe or persistent symptoms.