A 42-year-old woman with a 1-year history of rheumatoid arthritis comes to see you complaining of worsening symptoms. She has been taking leflunomide. You know that IL-1 and TNF-α are two key cytokines involved in the negative sequelae of rheumatoid arthritis. You decide to give her anakinra to interfere with IL-1 signaling. Which of the following is the most common side effect of anakinra administration?

Correct Answer: D

Rationale: Anakinra, an IL-1 antagonist, commonly causes injection site reactions , due to subcutaneous delivery. Blurry vision , diarrhea , headache , and nausea (E) are less frequent. This local irritation is expected in RA treatment escalation.

Correct Answer: B

Rationale: Phosphodiesterase inhibitors (Erectile Dysfunction medications) are contraindicated with nitroglycerin due to the potential for severe hypotension and cardiovascular collapse when taken together. It is essential for the nurse to inform the provider before administering nitroglycerin if the patient is taking phosphodiesterase inhibitors to prevent any harmful interactions.

Correct Answer: B

Rationale: The therapeutic levels for digoxin are typically considered to be between 0.5 % 2 ng/mL. This range is associated with optimal therapeutic effects of digoxin in managing heart conditions such as heart failure and atrial fibrillation. Levels below 0.5 ng/mL may be subtherapeutic while levels above 2 ng/mL can lead to toxicity symptoms like nausea, vomiting, visual disturbances, and cardiac arrhythmias. Monitoring digoxin levels within the therapeutic range ensures the medication is effective and safe for the patient.

Correct Answer: A

Rationale: Aspirin's antiplatelet effect risks GI bleeding, causing dark stools , a serious adverse effect needing urgent assessment. Nasal stuffiness , photophobia , and nocturia aren't typical. A signals potential hemorrhage, making it the correct adverse effect.

Correct Answer: D

Rationale: Memantine, an NMDA glutamate receptor antagonist, manages Alzheimer's by reducing excitotoxicity from excessive glutamate, which contributes to neuronal damage in later stages. It complements acetylcholinesterase inhibitors (e.g., donepezil), which boost cholinergic function for memory, by targeting a different pathway, slowing progression and improving behavior. Rivastigmine and donepezil are acetylcholinesterase inhibitors, not glutamate antagonists. Ropinirole, a dopamine agonist, treats Parkinson's. Fluoxetine, an SSRI, addresses depression. Memantine's unique glutamate modulation, combined with cholinergic enhancement, offers a dual approach, supported by evidence for moderate-to-severe Alzheimer's management.

Correct Answer: A

Rationale: Fluoxetine, an SSRI, is a common cause of serotonin syndrome when used alone or in combination with other serotonergic agents.

Correct Answer: C

Rationale: High drug costs stem from research, development, and production expenses-years of trials and manufacturing-requiring companies to recover investments, a factual explanation. Insurance coverage sidesteps the question. Advertising adds cost but isn't primary. Accountability is opinion, not answer. Development costs provide a clear, neutral reason, educating the client on pharmaceutical economics.

Correct Answer: D

Rationale: Anakinra, an IL-1 antagonist, commonly causes injection site reactions , due to subcutaneous delivery. Blurry vision , diarrhea , headache , and nausea (E) are less frequent. This local irritation is expected in RA treatment escalation.

Correct Answer: A

Rationale: Albuterol is typically administered through inhalation as an aerosol or nebulized solution to provide quick relief of bronchospasm in conditions such as asthma or chronic obstructive pulmonary disease. It can also be administered intravenously in emergency situations for severe bronchospasm or anaphylaxis. Albuterol is not formulated as an extended-release oral medication due to the need for rapid onset of action in managing acute bronchospasm.