A 52-year-old woman presents to the primary care clinic with progressive weakness and muscle aches for the past month. She can still do her daily tasks but can notice a difference in her strength. When she lies down at night, her legs always ache. Her electrolytes are significant for a K⁺ of 2.9 mEq/L. She was recently started on a diuretic for peripheral edema. She is pleased that she has not had peripheral edema since starting the diuretic. What is the most appropriate diuretic to treat this patient?

Correct Answer: A

Rationale: The most appropriate diuretic to treat this patient is Spironolactone (Option A). Spironolactone is a potassium-sparing diuretic that helps retain potassium in the body. In this case, the patient has hypokalemia (low potassium levels), which can be exacerbated by other diuretics that cause potassium loss, such as loop diuretics like Furosemide (Option B) and thiazide diuretics like Hydrochlorothiazide (Option C). Mannitol (Option D) is an osmotic diuretic used in specific situations like reducing intracranial pressure and is not indicated for the patient's symptoms. Educationally, understanding the different classes of diuretics and their mechanisms of action is crucial for selecting the appropriate diuretic for specific patient presentations. In this scenario, recognizing the need for a potassium-sparing diuretic like Spironolactone in a patient with hypokalemia due to another diuretic is essential to prevent further electrolyte imbalances and address the patient's symptoms effectively. This case highlights the importance of individualizing treatment based on patient characteristics and drug mechanisms to optimize therapeutic outcomes.

Correct Answer: D

Rationale: The correct answer is D) Methyldopa. Methyldopa is known to cause a positive Coombs' test, indicating hemolytic anemia as a potential side effect. Methyldopa is a prodrug that is metabolized to form a reactive metabolite that can bind to red blood cells, leading to antibody formation and subsequent hemolysis. This adverse effect is unique to Methyldopa among the listed antihypertensive drugs. Option A) Captopril is an ACE inhibitor and is not associated with causing a positive Coombs' test. Option B) Clonidine is an alpha-2 adrenergic agonist and does not typically lead to a positive Coombs' test. Option C) Labetalol is a combined alpha and beta blocker and is not commonly linked to hemolytic anemia or a positive Coombs' test. Educationally, understanding the potential side effects of medications used in managing cardiovascular conditions is crucial for healthcare professionals. Recognizing adverse reactions like a positive Coombs' test can prompt timely intervention and prevent further complications in patients. It highlights the importance of monitoring and assessing patients regularly for both intended therapeutic effects and potential adverse drug reactions.

Correct Answer: C

Rationale: The correct answer is C: “Weight gain is a common, but troubling, side effect.” This response acknowledges the client's concern, validates their experience, and provides accurate information. Weight gain is a known side effect of lithium carbonate, affecting a significant number of individuals. It is essential for the nurse to acknowledge this common side effect to educate and support the client effectively. Choice A is incorrect because weight gain, not weight loss, is typically associated with lithium carbonate. Choice B is incorrect as it implies the client is solely responsible for the weight gain, which may lead to feelings of guilt or shame. Choice D is incorrect because weight gain can occur beyond the first month of treatment with lithium carbonate.

Correct Answer: B

Rationale: Correct Answer: B - Beginning administration of haloperidol (Haldol) decanoate Rationale: Haloperidol decanoate is a long-acting injectable form of haloperidol, ensuring consistent medication levels even if the patient forgets to take oral medication. This promotes compliance and prevents relapse. Summary of other choices: A: Having friends monitor medications may not address the issue of forgetting to take the medication and may not be reliable. C: Detailed instructions may not address the underlying issue of noncompliance and may not ensure consistent medication administration. D: Changing to an atypical antipsychotic may not address the noncompliance issue and may not be necessary if the patient responds well to haloperidol.

Correct Answer: C

Rationale: The correct answer is C: Olanzapine (Zyprexa). The nurse will likely choose olanzapine because it is an atypical or second-generation antipsychotic drug that is effective in treating negative symptoms, muscle stiffness, and motor restlessness associated with schizophrenia. Olanzapine has a lower risk of extrapyramidal side effects compared to haloperidol, making it a safer option for the patient. Chlorpromazine (A) is an older typical antipsychotic with similar side effect profile as haloperidol. Clozapine (B) is effective for treatment-resistant schizophrenia but is not typically a first choice due to its potential for serious side effects. Fluoxetine (D) is an antidepressant and not typically used as a first-line treatment for schizophrenia symptoms.