Which patient is the best candidate to receive nesiritide therapy?

Correct Answer: D

Rationale: Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP) that is used for the treatment of acutely decompensated heart failure (HF). It is specifically indicated for patients with acute decompensated HF who have dyspnea at rest. Nesiritide works by promoting vasodilation and natriuresis, which helps alleviate symptoms of acute decompensated HF such as dyspnea and edema. Therefore, the patient with acutely decompensated HF who has dyspnea at rest is the best candidate to receive nesiritide therapy to help improve their symptoms and hemodynamic status.

Correct Answer: B

Rationale: The therapeutic range for digoxin levels is typically considered to be between 0.5 to 2.0 ng/mL for patients with heart failure. A digoxin level of 1.1 ng/mL falls within this range, indicating that the patient's digoxin level is appropriate for therapeutic effects. This level suggests that the patient is receiving an appropriate dose of digoxin to achieve the desired therapeutic response without reaching toxic levels.

Correct Answer: A

Rationale: Warfarin is an anticoagulant medication that works by inhibiting the production of certain clotting factors in the liver, specifically factors II, VII, IX, and X. By doing so, warfarin prevents the formation of new blood clots. It does not have the ability to dissolve existing blood clots, as that function is typically carried out by different types of medications known as thrombolytics. Warfarin is commonly prescribed to prevent and treat blood clots in conditions such as atrial fibrillation, deep vein thrombosis, and pulmonary embolism.

Correct Answer: A

Rationale: Mefloquine is an antimalarial drug that can cause hepatotoxicity, so liver enzyme tests are often ordered to monitor for liver damage. Blood glucose, sputum culture, and white blood cell count are not directly related to mefloquine use.

Correct Answer: C

Rationale: Propranolol goes through extensive first-pass hepatic metabolism. This means that after oral administration, a significant portion of the drug is metabolized by the liver before it reaches systemic circulation. This process reduces the bioavailability of propranolol. As a result, higher doses are often required for oral administration compared to other routes of administration, such as intravenous. Heparin, insulin, nitroglycerine, and warfarin do not undergo extensive first-pass metabolism in the liver.