A 39-year-old man who suffered a work-related injury has chronic back pain. A morphine pain pump was implanted to control his chronic pain. Formerly, he had chronic diarrhea which is now much improved. What is the most likely explanation for this finding?

Correct Answer: B

Rationale: Morphine, an opioid, improves chronic diarrhea by increasing intestinal circular muscle tone . Opioids slow GI motility via μ-receptors, enhancing tone and reducing peristalsis. Option , improved motility, opposes this. Options , , and (E) weaken continence or motility, not fitting. This constipating effect explains the improvement, a common opioid side effect.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Naproxen sodium. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can help in relieving pain but can worsen gastrointestinal symptoms such as gastroesophageal reflux and abdominal pain. Choline magnesium trisalicylate (Option A) is a salicylate NSAID that can also cause gastrointestinal side effects but is less likely to worsen symptoms compared to naproxen. Celecoxib (Option B) is a selective COX-2 inhibitor that is less likely to cause gastrointestinal side effects compared to traditional NSAIDs like naproxen. Ketorolac (Option C) is a potent NSAID that can cause significant gastrointestinal side effects similar to naproxen. In an educational context, it is crucial for healthcare providers to understand the side effect profiles of different pain medications, especially in patients with pre-existing conditions like gastroesophageal reflux. This knowledge helps in making informed decisions when choosing appropriate medications for pain management while considering individual patient factors.

Correct Answer: D

Rationale: Paliperidone, a second-generation antipsychotic, treats schizoaffective disorder's psychotic and mood symptoms via D2 and 5HT2 antagonism. Its moderate sedative effect, less than chlorpromazine's, can aid sleep onset without excessive drowsiness, fitting her insomnia complaint. Lithium stabilizes mood but doesn't sedate or address psychosis directly. Chlorpromazine, a sedating first-generation antipsychotic, risks oversedation and EPS. Haloperidol, non-sedating, controls psychosis but not mood or sleep. Ziprasidone lacks strong sedation. Paliperidone's balanced profile manages her condition holistically, improving sleep while targeting core symptoms, per evidence.

Correct Answer: D

Rationale: Antihistamines, particularly first-generation ones (e.g., diphenhydramine), block H1 receptors but cross the blood-brain barrier, causing sedation. The statement 'This medication could make me very sleepy' shows the client understands this key side effect, indicating effective education. Alcohol exacerbates sedation, so that's incorrect. Increased fluids aren't specifically required unless addressing dry mouth, a secondary issue. OTC status doesn't guarantee safety, a common misconception. The nurse evaluates learning by the client's recognition of drowsiness, critical for safety (e.g., avoiding driving), making choice D the best evidence of comprehension.

Correct Answer: A

Rationale: The correct answer is A) "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects." This response is the best because it accurately explains the pharmacokinetics of inhaled albuterol. By inhaling the medication, it is directly delivered to the lungs where it can quickly enter the bloodstream and start working, providing faster relief for respiratory symptoms like bronchospasm. Option B is incorrect because pills can also be effective in treating various illnesses, but in the case of albuterol for respiratory conditions, inhaled medications are preferred due to their faster onset of action and targeted delivery to the lungs. Option C is incorrect because the route of administration (inhaled vs. oral) does not necessarily determine the number of side effects. Side effects are more related to the specific medication and individual patient factors rather than the route of administration. Option D is incorrect because the effectiveness of a medication is not solely determined by the route of administration. Both inhaled and oral forms of albuterol can be effective, but inhaled albuterol is preferred for conditions requiring rapid relief of bronchospasm. Educational Context: Understanding the pharmacokinetics and rationale behind selecting a specific route of medication administration is crucial for nurses to provide safe and effective care to their patients. In the case of inhaled albuterol, the rapid onset of action and localized effects in the lungs make it the preferred route for treating acute respiratory conditions like asthma or COPD exacerbations.