A 15-year-old female presents to her primary care physician complaining of runny nose and itchy eyes. She said that she first had these symptoms during the spring a few years ago, but each year, they have been bothering her more. You know there are multiple ways to interfere with the signaling that is causing her symptoms. Which of the following drugs would prevent the release of the main chemical mediator in her case?

Correct Answer: A

Rationale: The patient's symptoms-runny nose and itchy eyes during spring-suggest seasonal allergic rhinitis, where histamine is the main chemical mediator released from mast cells. Cromolyn sodium stabilizes mast cells, preventing histamine release, making it a prophylactic agent ideal for this scenario. Diphenhydramine is an H1 antihistamine that blocks histamine receptors after release, not preventing its release, so it's incorrect. Ranitidine is an H2 blocker, affecting gastric acid secretion, not allergic histamine pathways. Loratadine is another H1 antihistamine, also acting post-release. Theophylline (E) is a bronchodilator, irrelevant here. The question emphasizes preventing release, not blocking effects, so Cromolyn sodium stands out. Its mechanism directly addresses the root cause by stabilizing mast cells before allergen exposure triggers histamine release, offering a preventative rather than symptomatic approach, which aligns with the patient's recurring seasonal issue.

Correct Answer: A

Rationale: Altered nutrition is often the priority nursing diagnosis for clients undergoing chemotherapy because the treatment can cause side effects such as nausea, vomiting, anorexia, and mucositis, leading to malnutrition and weight loss. Proper nutrition is essential for maintaining strength, supporting the immune system, and promoting recovery. While fear, anxiety, and decreased cardiac output are valid concerns, addressing nutritional deficits is critical to the client's overall well-being and ability to tolerate treatment.

Correct Answer: B

Rationale: Bruising and petechiae on a patient's extremities are signs of potential thrombocytopenia, which is a decrease in platelet count. Warfarin (Coumadin) is an anticoagulant that works by interfering with the body's ability to use vitamin K to form blood clots. While the International normalized ratio (INR) is often used to monitor the effectiveness of warfarin therapy, and PTT and aPTT may also be relevant in certain cases, the presence of bruising and petechiae suggest a potential issue with platelet levels. Therefore, checking the patient's platelet level with a laboratory test is appropriate in this situation to assess for thrombocytopenia.

Correct Answer: C

Rationale: Nystatin is an antifungal medication used to treat fungal infections, such as candidiasis. Before administration, assessing whether the client could be pregnant is critical because nystatin's safety in pregnancy is not fully established (Category C), meaning potential risks to the fetus cannot be ruled out without further evaluation. This makes pregnancy status a key safety consideration to prevent harm to an unborn child, outweighing other factors in urgency. The type of diet or amount of fat might influence general health or drug absorption minimally but isn't directly critical to nystatin's administration. Height and weight could affect dosing in some medications, but nystatin's dosing is typically standard and not weight-based for most fungal infections. Thus, confirming pregnancy status ensures the drug's safety profile aligns with the client's condition, making choice C the most critical assessment data to review prior to administration.

Correct Answer: B

Rationale: Tricyclic antidepressants (TCAs) like imipramine block norepinephrine and serotonin reuptake, but their anticholinergic effects are significant. In glaucoma, particularly angle-closure type, these effects can increase intraocular pressure by dilating pupils and obstructing aqueous humor outflow, risking acute attacks—thus, they're contraindicated. TCAs lower seizure threshold, lacking anticonvulsant activity, and may exacerbate epilepsy. They don't enhance levodopa absorption; rather, they might interact via monoamine pathways, but this isn't a primary effect. Some TCAs (e.g., amitriptyline) have quinidine-like sodium channel blockade, giving antiarrhythmic properties, but this isn't their primary use. The glaucoma concern is critical due to the anticholinergic mechanism, making it a key clinical consideration and the most accurate statement here.