A 57-year-old homeless man with no health insurance has a history of hypertension. He usually takes an antihypertensive agent but has not been able to obtain the medication. He stopped taking the medication yesterday and now is found collapsed in front of a shopping mall. Rescue squad arrives on the scene, and the patient's blood pressure is 190/110 mm Hg. Which one of the following antihypertensive drugs can precipitate a hypertensive crisis following abrupt cessation of therapy?

Correct Answer: A

Rationale: The correct answer is A) Clonidine. Clonidine is an alpha-2 adrenergic agonist used to lower blood pressure. Abrupt cessation of clonidine can lead to a hypertensive crisis due to rebound hypertension. Clonidine acts by reducing sympathetic outflow from the central nervous system, so sudden withdrawal can cause a surge in sympathetic activity, leading to a rapid rise in blood pressure. Option B) Diltiazem is a calcium channel blocker that does not typically cause a hypertensive crisis upon abrupt cessation. It works by relaxing blood vessels and lowering blood pressure gradually. Option C) Enalapril is an ACE inhibitor that also does not cause a hypertensive crisis when stopped suddenly. It works by dilating blood vessels and reducing blood volume. Option D) Hydrochlorothiazide is a diuretic that helps lower blood pressure by reducing fluid volume and is not associated with a hypertensive crisis upon abrupt cessation. This scenario highlights the importance of patient education on the risks of abruptly stopping antihypertensive medications and the need for consistent access to healthcare to prevent complications like hypertensive crises. It also underscores the critical role of healthcare professionals in ensuring patient compliance and continuity of care for chronic conditions like hypertension.

Correct Answer: D

Rationale: In this question, option D, "Amiodarone is an antiarrhythmic drug," is correct. Amiodarone is indeed classified as a Class III antiarrhythmic medication. Option A, "Amlodipine is an angiotensin converting enzyme (ACE) inhibitor," is incorrect because amlodipine belongs to the calcium channel blocker class of medications, not ACE inhibitors. It is commonly used to treat hypertension and angina. Option B, "Hydralazine decreases renin release," is incorrect. Hydralazine is a direct-acting vasodilator that works by relaxing the smooth muscle in blood vessels to lower blood pressure. It does not affect renin release. Option C, "Lidocaine is used in the treatment of heart failure," is incorrect. Lidocaine is a local anesthetic and antiarrhythmic agent used primarily for ventricular arrhythmias, not heart failure. Understanding the classification of cardiovascular drugs is crucial for healthcare professionals to prescribe medications effectively and understand their mechanisms of action. It helps in selecting the most appropriate drug for a specific condition, thereby improving patient outcomes. Knowing the correct classification can also prevent medication errors and adverse reactions.

Correct Answer: A

Rationale: The correct answer is A: White blood cell count. Clozapine can lead to agranulocytosis, a potentially life-threatening condition characterized by a severe decrease in white blood cells. By evaluating the baseline white blood cell count, the nurse can monitor for any significant drops during therapy. Liver function studies (choice B), creatinine clearance (choice C), and blood urea nitrogen (choice D) are important to monitor for other potential side effects of clozapine but are not specifically related to recognizing agranulocytosis.

Correct Answer: D

Rationale: The correct answer is D, Major depressive episode, because it specifically refers to a period of intense sadness, loss of interest or pleasure, and other symptoms like changes in sleep, appetite, and energy levels. This distinguishes it from the other options. A, Bipolar disorder: mania, involves periods of elevated mood and energy alternating with depressive episodes. B, Schizophrenia spectrum disorder, includes symptoms like hallucinations, delusions, and disorganized thinking. C, Generalized anxiety disorder, is characterized by excessive worry and anxiety. Therefore, the specific symptoms described in the question point to major depressive episode as the correct answer.

Correct Answer: D

Rationale: Rationale: The correct answer is D because monitoring sodium intake is not a specific indicator related to the side effects of MAOIs like phenelzine. Monitoring dietary restrictions such as avoiding sausages, chocolate, and Chinese food, as well as wearing elastic hose and supportive shoes to prevent postural hypotension are essential in managing potential side effects of MAOIs. These monitoring parameters are directly related to the mechanism of action and potential side effects of MAOIs, unlike maintaining a stable sodium intake which is not a specific concern with these medications.