The nurse is preparing to discharge a client newly prescribed a progestin-only pill (POP) for contraceptive prevention. Which contraindication associated with POP would the nurse alert the healthcare provider?
The client has a BMI of >30
The client is currently taking Ginger
The client has a history of hypertension
The client has no intention of conceiving within the year
The Correct Answer is C
A. A BMI greater than 30 is a consideration, but it is not an absolute contraindication for the use of POPs.
B. Ginger does not interact adversely with progestin-only pills and is not a contraindication.
C. A history of hypertension can increase the risk of cardiovascular events, and while POPs are generally safer than combined hormonal contraceptives for women with hypertension, it should still be monitored and reported to the healthcare provider.
D. Having no intention of conceiving is not a contraindication; in fact, it is a common reason for using contraceptive methods like POPs.
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Correct Answer is ["B","C","F"]
Explanation
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.
Correct Answer is D
Explanation
A. A shuffling gait is more commonly associated with parkinsonism, a side effect of antipsychotic medications, rather than tardive dyskinesia.
B. A sudden onset of high fever could indicate neuroleptic malignant syndrome (NMS), which is a serious reaction to antipsychotic medications, not tardive dyskinesia.
C. Constant tapping of feet when sitting can indicate restlessness or akathisia, but it does not specifically represent tardive dyskinesia.
D. Twisting tongue movements are a classic manifestation of tardive dyskinesia, characterized by involuntary, repetitive movements of the face, tongue, and extremities, which may develop after long-term use of antipsychotic medications like fluphenazine.