A 59-year-old man with hypertension, gastroesophageal reflux disorder, AIDS, seizure disorder, and depression is currently maintained on multiple medications, including propranolol. He does not have his medication list at his current office visit with his primary care physician. His blood pressure is 180/100 mm Hg. The patient states that he is taking all of his medications as scheduled. Which of the following drugs is the most likely explanation of this finding?

Correct Answer: D

Rationale: The patient's uncontrolled hypertension (180/100 mm Hg) despite propranolol, a β-blocker, suggests a drug interaction. Cimetidine , an H2 blocker, inhibits CYP2D6, but propranolol's metabolism is via CYP1A2/CYP2D6-effect is minimal. Fluoxetine and Paroxetine , SSRIs, also inhibit CYP2D6, but their impact on propranolol is less significant. Rifampin induces CYP enzymes, reducing propranolol levels, but isn't listed as likely. Ritonavir (E), a protease inhibitor for AIDS, potently inhibits CYP3A4 and CYP2D6, increasing propranolol levels, yet here it paradoxically fails to control BP, possibly due to complex polypharmacy or adherence issues. Ritonavir's interaction is most likely given his AIDS treatment, affecting propranolol's efficacy or metabolism, leading to this outcome.

Correct Answer: A

Rationale: When a patient taking high-dose aspirin for arthritis requires prednisone for an acute flare, the nurse should be aware that prednisone can increase blood glucose levels. As such, the nurse should monitor the patient for signs and symptoms of hyperglycemia, not hypoglycemia. It is essential to closely monitor the patient's blood glucose levels to prevent complications associated with high blood sugar levels, such as hyperglycemia. It is also crucial to educate the patient about the potential side effects of prednisone and instruct the patient on how to manage blood glucose levels while taking the medication.

Correct Answer: A

Rationale: Amitriptyline, a tricyclic antidepressant, typically requires 2 to 6 weeks to achieve full therapeutic effect, as it gradually increases neurotransmitter levels (e.g., serotonin, norepinephrine) in the brain to alleviate depression. After only 2 weeks, the patient's continued symptoms are expected, not indicative of failure, making choice A the best response: it educates the patient on the timeline, fostering adherence. Choice B dismisses the patient's feelings with subjective reassurance, undermining trust. Choice C prematurely suggests switching drugs without evidence, risking unnecessary changes. Choice D exaggerates the timeline to months, which is inaccurate and discouraging. The nurse's role is to provide accurate information and support, reinforcing that delayed onset is normal for this class of medication, thus making choice A the most therapeutic and evidence-based response.

Correct Answer: D

Rationale: Amitriptyline, a tricyclic antidepressant, has anticholinergic effects that slow gastric motility, reducing the rate of gastric emptying.

Correct Answer: D

Rationale: The patient's uncontrolled hypertension (180/100 mm Hg) despite propranolol, a β-blocker, suggests a drug interaction. Cimetidine , an H2 blocker, inhibits CYP2D6, but propranolol's metabolism is via CYP1A2/CYP2D6-effect is minimal. Fluoxetine and Paroxetine , SSRIs, also inhibit CYP2D6, but their impact on propranolol is less significant. Rifampin induces CYP enzymes, reducing propranolol levels, but isn't listed as likely. Ritonavir (E), a protease inhibitor for AIDS, potently inhibits CYP3A4 and CYP2D6, increasing propranolol levels, yet here it paradoxically fails to control BP, possibly due to complex polypharmacy or adherence issues. Ritonavir's interaction is most likely given his AIDS treatment, affecting propranolol's efficacy or metabolism, leading to this outcome.