A 33-year-old female is brought to the emergency department by her mother. The patient had a sudden onset of fever and her temperature is now 40°C (104°F). She has no sick contacts. The mother mentions that she is on a medication for schizophrenia but could not remember the name. A complete blood count shows 250 neutrophils per microliter. Which of the following medications is she likely taking?

Correct Answer: A

Rationale: Fever and severe neutropenia (250 neutrophils/μL) in a schizophrenic patient suggest clozapine . Clozapine causes agranulocytosis, a rare but serious side effect requiring monitoring. Olanzapine , Quetiapine , Risperidone , and Haloperidol (E) rarely cause this. Clozapine's risk explains the acute presentation, necessitating immediate cessation.

Correct Answer: C

Rationale: In this scenario, the most likely explanation for the patient's symptoms of acute abdominal pain, inability to pass flatus or bowel movement after being prescribed Ditropan for urinary frequency while on amitriptyline is paralytic ileus (Option C). Paralytic ileus is a condition characterized by the temporary cessation of bowel motility, which can be caused by certain medications like anticholinergics such as Ditropan. Option A, alcoholic hepatitis, is less likely in this case as the patient's symptoms are more indicative of a gastrointestinal issue rather than liver inflammation. Option B, pancreatitis, is also less likely as the symptoms presented are more consistent with a bowel motility issue rather than pancreatic inflammation. Option D, a supratherapeutic dose of medication, is not the most likely explanation as the symptoms are more in line with a side effect of the medication rather than an overdose. Educationally, this case highlights the importance of recognizing potential adverse effects and drug interactions when managing patients on multiple medications. Understanding the mechanisms of action and side effect profiles of medications is crucial in providing safe and effective patient care. It also underscores the need for thorough patient assessment and monitoring to promptly identify and address any complications that may arise during pharmacological management.

Correct Answer: A

Rationale: Ethosuximide treats absence seizures by blocking T-type calcium channels in thalamic neurons, reducing 3 Hz spike-and-wave discharges that disrupt attention, ideal for school-aged children. Carbamazepine, a sodium channel blocker, controls focal and tonic-clonic seizures but worsens absence seizures. Diazepam manages acute seizures, not chronic absence. Carbamazepine plus primidone targets other seizure types, not absence. Watchful waiting risks educational impact. Ethosuximide's specificity, efficacy, and pediatric safety make it the most appropriate, per guidelines.

Correct Answer: B

Rationale: Oral decongestants (e.g., pseudoephedrine) act systemically, vasoconstricting vessels beyond the nose, causing effects like hypertension , unlike intranasal decongestants (e.g., oxymetazoline), which are localized but risk rebound congestion. Oral efficacy isn't inherently superior; it's slower. Rebound is nasal-specific. High efficacy is vague. Choice B highlights systemic impact, a key distinction nurses must recognize for safe administration.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) The client is pregnant. Fluticasone (Flonase) is a corticosteroid that is used to reduce inflammation in the nasal passages. During pregnancy, the use of certain medications, including corticosteroids, must be carefully monitored due to their potential effects on the developing fetus. Fluticasone may pose risks to the fetus, especially if used in high doses or for prolonged periods. Option A) The client has diabetes mellitus: This condition is not a contraindication for the use of fluticasone. While individuals with diabetes may need closer monitoring due to potential effects on blood sugar levels, it does not warrant holding the drug. Option C) The client has glaucoma: Although corticosteroids can increase intraocular pressure and worsen glaucoma, fluticasone nasal spray is typically considered safe for individuals with glaucoma as long as it is used as directed and does not come into direct contact with the eyes. Option D) The client has hypertension: Fluticasone nasal spray is not known to significantly impact blood pressure, so hypertension alone would not be a reason to hold the drug. Educationally, this question highlights the importance of assessing the appropriateness of medication use in specific patient populations. Understanding contraindications and precautions associated with medications is crucial for safe nursing practice, especially when caring for vulnerable populations like pregnant individuals. Nurses must advocate for their patients by recognizing when to hold a medication and communicate effectively with the healthcare team to ensure safe and effective care.