A 63-year-old woman with congestive heart failure begins to have lower extremity swelling. She starts taking a diuretic and the swelling improves significantly. Over the next few days, however, she develops ringing in her ears. Which of the following diuretics is she taking?

Correct Answer: B

Rationale: Diuretics treat CHF edema, but tinnitus suggests a side effect. Furosemide , a loop diuretic, causes ototoxicity (ringing in ears) at high doses. Acetazolamide , a carbonic anhydrase inhibitor, doesn't typically cause this. Hydrochlorothiazide , a thiazide, rarely affects hearing. Mannitol , an osmotic diuretic, and Spironolactone (E), an aldosterone antagonist, lack ototoxicity. Furosemide's rapid action on edema fits CHF, but its cochlear toxicity explains the symptom, common in loop diuretics.

Correct Answer: D

Rationale: Alcohol dehydrogenase (ADH) is the enzyme responsible for metabolizing ethanol in the liver. The correct answer is D) Inhibited by fomepizole. Fomepizole is a competitive inhibitor of ADH and is used in cases of alcohol poisoning to prevent the conversion of ethanol to toxic metabolites. This inhibitory action of fomepizole on ADH helps in treating alcohol intoxication effectively. Option A) Acts on acetaldehyde is incorrect because acetaldehyde is the product of alcohol metabolism, not the substrate for ADH. Option B) Acts on acetate is incorrect because ADH acts on ethanol, not acetate. Option C) Inhibited by disulfiram is incorrect because disulfiram inhibits aldehyde dehydrogenase, not alcohol dehydrogenase. In an educational context, understanding the role of enzymes like alcohol dehydrogenase in alcohol metabolism is crucial for healthcare professionals to manage patients with alcohol-related issues effectively. Knowledge of enzyme inhibitors like fomepizole can be life-saving in cases of alcohol poisoning. This knowledge helps in providing appropriate treatment and preventing further complications related to alcohol consumption.

Correct Answer: C

Rationale: Teriflunomide, used in multiple sclerosis, inhibits dihydroorotate dehydrogenase, blocking pyrimidine synthesis critical for lymphocyte proliferation, reducing CNS inflammation by limiting activated immune cells. Riluzole modulates glutamate for ALS, not immunity. Rotigotine, a dopamine agonist, treats Parkinson's. Dexamethasone, a corticosteroid, suppresses inflammation broadly via glucocorticoid pathways, not pyrimidine-specific mechanisms. Teriflunomide's targeted action on lymphocyte replication distinguishes it in MS, decreasing relapses by curbing immune-mediated damage, a precise fit for this description.

Correct Answer: A

Rationale: Oxytocin induces labor by stimulating uterine contractions, but excessive use can cause hyperstimulation, leading to continuous, sustained contractions . This risks uterine rupture or fetal distress, necessitating immediate cessation of the infusion to protect mother and baby. Transition is a labor stage, not a reason to stop unless complications arise. Strong contractions are expected, and regular contractions every 2-3 minutes are normal for labor induction. The nurse stops the infusion for sustained contractions due to their potential for catastrophic outcomes, making choice A the most likely trigger based on oxytocin's safety profile.

Correct Answer: D

Rationale: Respiratory alkalosis occurs when there is a decrease in carbon dioxide levels in the blood, leading to an increase in pH. The correct answer is D) hyperventilation because when a person breathes rapidly and shallowly, excess carbon dioxide is expelled from the body, causing respiratory alkalosis. Option A) hypotension refers to low blood pressure and is not a direct cause of respiratory alkalosis. Option B) hypertension, or high blood pressure, is also not a direct cause of respiratory alkalosis. Option C) hypoventilation, which is insufficient breathing, would actually lead to an accumulation of carbon dioxide in the blood, causing respiratory acidosis, the opposite of respiratory alkalosis. Educationally, understanding the causes of respiratory alkalosis is crucial for nursing students and healthcare professionals to assess and manage patients experiencing acid-base imbalances. Recognizing the relationship between respiratory rate and pH levels is essential for providing appropriate care and interventions for patients with respiratory conditions.