A 13-year-old female presents with 3 months of easy bruisability and bone pain. Complete blood count shows extreme leukocytosis. She is diagnosed with ALL and begins a chemotherapy regimen. One of her chemotherapeutic drugs is cyclophosphamide. What should also be given to avoid a potentially serious side effect of cyclophosphamide?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Mesna. Mesna is a uroprotective agent commonly used with cyclophosphamide to prevent hemorrhagic cystitis, a potentially serious side effect of the chemotherapy drug. Cyclophosphamide can cause bladder toxicity, leading to inflammation and hemorrhage in the bladder mucosa. Mesna works by binding to acrolein, a toxic metabolite of cyclophosphamide, and reducing its harmful effects on the bladder lining. Option B) Methylene blue is not indicated in this case as it is used as an antidote for methemoglobinemia, not for preventing cyclophosphamide-induced hemorrhagic cystitis. Option C) N-acetylcysteine is mainly used for acetaminophen overdose to prevent liver toxicity and is not relevant in preventing cyclophosphamide-induced bladder toxicity. Option D) Ibuprofen is a non-steroidal anti-inflammatory drug that does not provide protection against cyclophosphamide-induced bladder toxicity. From an educational perspective, understanding the rationale behind the use of Mesna with cyclophosphamide highlights the importance of supportive care in managing chemotherapy side effects. Healthcare providers need to be aware of the appropriate supportive medications to mitigate potential toxicities associated with chemotherapy drugs to ensure the best outcomes for pediatric patients undergoing cancer treatment.

Correct Answer: B

Rationale: In this scenario, the most important therapy to initiate in the patient who ingested a toxic amount of digoxin is option B) Digoxin immune Fab. Digoxin immune Fab is the specific antidote for digoxin toxicity. It works by binding to the digoxin in the body, forming a complex that is then excreted by the kidneys, effectively reducing the circulating levels of digoxin and reversing its toxic effects. Option A) Amiodarone is used for treating certain heart rhythm problems but is not the first-line treatment for digoxin toxicity. Option C) Lidocaine is a local anesthetic and antiarrhythmic drug, not indicated for digoxin toxicity. Option D) Potassium salts may be used to correct potassium imbalances caused by digoxin toxicity, but Digoxin immune Fab is the priority in this acute scenario. From an educational perspective, understanding the specific antidotes and treatments for common drug toxicities is crucial for healthcare professionals to effectively manage overdose situations. In this case, recognizing the importance of Digoxin immune Fab as the specific antidote for digoxin toxicity highlights the significance of prompt and appropriate intervention in toxicological emergencies.

Correct Answer: D

Rationale: Lamotrigine, a broad-spectrum antiepileptic, treats absence seizures by stabilizing sodium channels and inhibiting glutamate release, though less specific than ethosuximide. Topiramate and levetiracetam manage multiple seizure types but aren't first-line for absence. Tiagabine, a GABA reuptake inhibitor, may worsen absence seizures. Zonisamide has broad efficacy but less absence focus. While ethosuximide is gold standard, lamotrigine's utility in absence, especially in mixed epilepsies, and clinical evidence make it the most useful here among options.

Correct Answer: D

Rationale: Actifed Plus combines acetaminophen (an analgesic) with antihistamine and decongestant, relieving pain alongside allergy symptoms. Sudafed PE and Triaminic contain chlorpheniramine and phenylephrine, no analgesics. Tavist has clemastine alone. Choice D's analgesic property distinguishes it, relevant for nurses advising on OTC options.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) The client may develop a hypertensive crisis. This is because the interaction between MAOIs and diphenhydramine can lead to a dangerous increase in blood pressure known as a hypertensive crisis. MAOIs inhibit the breakdown of certain neurotransmitters, including norepinephrine, which can then accumulate in the body. When combined with diphenhydramine, which also has anticholinergic effects that can further increase blood pressure, the risk of a hypertensive crisis is heightened. Option A is incorrect because the effectiveness of the MAOI in treating depression is not related to the interaction with diphenhydramine. Option B is incorrect as seizures are not a common consequence of this drug interaction. Option C is incorrect as diphenhydramine's ability to control allergies is not the primary concern when considering its interaction with MAOIs. Educationally, understanding drug interactions is crucial for healthcare professionals as they play a significant role in patient safety and treatment outcomes. Knowledge of how different medications can interact helps in making informed decisions about treatment plans and preventing harmful consequences for patients. This case highlights the importance of thorough medication reconciliation and communication between healthcare providers and patients to avoid potentially dangerous drug interactions.