The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order?

Interferon-B (IFN-B)

Mitoxantrone

Glatiramer acetate (Copaxone)

Methylprednisolone (Solu-Medrol)

Answer and Explanation

The Correct Answer is D

A) Interferon-B (IFN-B): Interferon-beta is a disease-modifying therapy (DMT) used for multiple sclerosis (MS) to reduce the frequency and severity of attacks and slow disease progression. However, it is not typically used during an acute exacerbation of MS. It is more commonly prescribed for long-term management of the disease.
B) Mitoxantrone: Mitoxantrone is an immunosuppressive agent that is used as a disease-modifying therapy for patients with more aggressive forms of MS. While it can be helpful in reducing the frequency of attacks, it is not the first-line treatment during an acute relapse. Mitoxantrone is often considered for long-term use when other therapies are not effective.
C) Glatiramer acetate (Copaxone): Glatiramer acetate is another disease-modifying therapy for MS. It works by altering the immune response to protect the myelin sheath. Like interferon-beta, it is used for long-term management, not for acute attacks. It is not typically used during an exacerbation of MS.
D) Methylprednisolone (Solu-Medrol): Methylprednisolone, a corticosteroid, is the standard treatment for acute exacerbations of multiple sclerosis. It works by reducing inflammation, which helps to decrease the severity of symptoms during an MS relapse. The nurse would anticipate this drug being prescribed to manage the acute inflammatory episode and speed recovery from the attack. This medication is often administered intravenously in high doses and then tapered as the patient stabilizes.

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Correct Answer is D

Explanation

A) The cell body of the first motor neuron that lies in the brain stem:
This option refers to the somatic nervous system, which controls voluntary muscle movements. In response to a stressful or fearful situation, like the one described, the sympathetic nervous system is activated, not the somatic motor pathways. This is more related to voluntary motor control rather than the autonomic response to stress.

B) Reflex circuitry produced by the ANS reflex:
The autonomic nervous system (ANS) is involved in regulating involuntary functions like heart rate, blood pressure, and digestion. However, the "racing heart" response described here is primarily triggered by the sympathetic division of the ANS due to a stressor, such as seeing the cat. The reflex itself is part of a larger autonomic reaction, but the direct cause of the increased heart rate is the secretion of neurotransmitters.

C) Parasympathetic effect on the vagus nerve:
The parasympathetic nervous system (PNS) generally works to counteract the "fight or flight" response, promoting a relaxed state and slowing the heart rate. The vagus nerve is the primary parasympathetic pathway involved in decreasing heart rate. However, during stress or a fear response, the parasympathetic system is overridden by the sympathetic system, which increases heart rate, making this option incorrect.

D) Secretion of the sympathetic neurotransmitters produced in the adrenal medulla:
When a person experiences a stressor, like the sudden appearance of a cat, the sympathetic nervous system is activated, triggering the release of neurotransmitters like norepinephrine from sympathetic nerve endings and epinephrine (adrenaline) from the adrenal medulla. These chemicals act on the heart, causing it to race in response to the perceived threat.

A. A 41-yr-old man with kidney stones B. A 62-yr-old woman with acute renal failure C. A 35-yr-old woman with cervical cancer D. A 50-yr-old man with cirrhosis of the liver

Correct Answer is D

Explanation

A) A 41-year-old man with kidney stones:
Kidney stones primarily affect the urinary system, and while the kidneys play a role in drug excretion, kidney stones themselves do not directly interfere with drug metabolism. Drug metabolism occurs mainly in the liver, so alterations due to kidney stones would be less likely. The liver is where most drug metabolism takes place, so drug metabolism in this case would likely be unaffected by kidney stones.

B) A 62-year-old woman with acute renal failure:
Acute renal failure impacts the kidneys' ability to filter and excrete drugs, but it doesn't directly affect the liver's ability to metabolize drugs. Renal failure can lead to drug accumulation due to decreased clearance, but metabolism (primarily liver function) is not usually altered unless the patient also has hepatic dysfunction.

C) A 35-year-old woman with cervical cancer:
Cervical cancer itself does not directly affect drug metabolism. While cancer treatments like chemotherapy or radiation therapy can affect liver and kidney function (which could impact drug metabolism), cervical cancer itself does not typically alter the metabolic pathways that drugs undergo in the body.

D) A 50-year-old man with cirrhosis of the liver:
Cirrhosis of the liver significantly impacts the liver's ability to metabolize drugs. The liver is the primary organ responsible for drug metabolism, and cirrhosis can lead to a decreased ability to break down medications, potentially resulting in drug toxicity or suboptimal therapeutic effects.

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The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order?

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Naxlex Comprehensive Predictor Exams

46) While walking down the street, a cat jumps out of an alley into the pathway of an adult. They note that his /her heart is "racing." this response is primarily due to:

Correct Answer is D

Explanation

Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?

Correct Answer is D

Explanation

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