A 24-year-old man complains of night sweats, weight loss, and pruritus over several weeks. Physical exam shows nontender lymphadenopathy. A lymph node biopsy reveals Reed-Sternberg cells. He is started on a chemotherapy regimen including one drug that works primarily by trapping cells in the mitotic (M) phase of the cell cycle. Which drug is this?

Correct Answer: D

Rationale: The correct answer is D) Vincristine. Vincristine works primarily by disrupting the formation of the mitotic spindle, which results in cells being trapped in the M phase of the cell cycle. This action inhibits cell division and leads to cell death, making it effective in treating cancers like Hodgkin's lymphoma, which is characterized by the presence of Reed-Sternberg cells. Option A) Bleomycin functions by causing DNA strand breaks. Option B) Cisplatin works by forming cross-links with DNA. Option C) Etoposide inhibits topoisomerase II enzyme. In an educational context, understanding the mechanisms of action of chemotherapy drugs is crucial for nurses and other healthcare professionals. Knowing how each drug works allows for the safe administration of medications, monitoring for side effects, and evaluating treatment efficacy. This knowledge also helps in anticipating and managing adverse reactions, ensuring optimal patient care during chemotherapy treatments.

Correct Answer: D

Rationale: The correct answer is D) Enzyme deficiency. In this scenario, the patient's development of scleral icterus (yellowing of the eyes) after starting chloroquine for malaria prophylaxis suggests an underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency is an inherited enzyme deficiency that can lead to hemolysis when exposed to certain drugs like chloroquine. This hemolysis results in the release of bilirubin, causing icterus. Option A) Biliary sludging is incorrect because the presentation of scleral icterus is not typical of biliary sludging. Option B) Chloroquine simply turns tears yellow is incorrect because icterus is a sign of bilirubin accumulation, not a color change from the drug. Option C) Drug interaction is less likely in this case compared to an enzyme deficiency. Understanding the relationship between G6PD deficiency and drug-induced hemolytic anemia is crucial for healthcare professionals, especially when prescribing medications to patients with this deficiency. Recognizing the signs and symptoms of hemolysis can prevent serious complications. This question also highlights the importance of considering a patient's individual genetic makeup and medical history when prescribing medications to ensure safe and effective treatment.

Correct Answer: D

Rationale: In this scenario, the primary care physician should be concerned about thrombotic thrombocytopenic purpura (TTP) in the patient taking clopidogrel due to the potential risk of drug-induced TTP. Clopidogrel is an antiplatelet medication that can rarely lead to TTP, a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia. Anemia (Option A), leukemia (Option B), and lymphoma (Option C) are not directly associated with clopidogrel use in the context of this question. While anemia can be a side effect of some chemotherapy drugs, it is not the primary concern in this case. Leukemia and lymphoma are types of blood cancers that are not specifically linked to clopidogrel use in the given scenario. Educationally, this question highlights the importance of recognizing potential adverse effects of medications, particularly in patients with specific medical histories. Understanding the side effect profiles of drugs and their potential interactions with a patient's existing conditions is crucial in clinical practice to ensure patient safety and optimal outcomes.

Correct Answer: B

Rationale: In this case, the correct answer is B) Haloperidol. The woman's presentation of repetitive, uncontrollable lip smacking and puckering is indicative of tardive dyskinesia, a side effect commonly associated with typical antipsychotic medications like haloperidol. Haloperidol, being a first-generation antipsychotic, has a higher propensity to cause extrapyramidal symptoms like tardive dyskinesia compared to atypical antipsychotics. A) Glipizide is a sulfonylurea used in diabetes management, which typically does not cause tardive dyskinesia. C) Hydrochlorothiazide is a diuretic commonly used for hypertension, not associated with tardive dyskinesia. D) Metformin is a biguanide used in diabetes treatment, not known to cause tardive dyskinesia. Educationally, understanding the side effect profiles of different medication classes is crucial for healthcare providers to make informed decisions regarding drug therapy. It highlights the importance of medication reconciliation and monitoring for adverse drug reactions, especially in patients on multiple medications like the one presented in the scenario. This case underscores the need for healthcare professionals to be vigilant for medication-induced movement disorders, particularly with antipsychotic use.

Correct Answer: D

Rationale: The correct answer is D) Streptomycin. Streptomycin belongs to the aminoglycoside class of antibiotics, which are known to have ototoxicity potential and can cause irreversible hearing loss in the fetus if taken during pregnancy. This is due to the drug's ability to cross the placental barrier and affect the developing fetal auditory system. A) Amoxicillin is a penicillin antibiotic and is considered safe for use during pregnancy as it does not pose a significant risk of harm to the fetus. B) Ciprofloxacin is a fluoroquinolone antibiotic that has been associated with cartilage abnormalities in developing animals but has not been definitively linked to hearing loss in human fetuses. C) Erythromycin is a macrolide antibiotic that is generally considered safe for use during pregnancy and does not have known ototoxic effects on the fetus. In an educational context, understanding the potential adverse effects of medications during pregnancy is crucial for healthcare providers, especially when treating pregnant women or women of childbearing age. Knowledge of which drugs can harm the fetus helps in making informed decisions to ensure the safety and well-being of both the mother and the developing baby. Healthcare professionals must be aware of the risks associated with certain medications to provide optimal care to pregnant patients.