A 65-year-old man undergoes an orthopaedic procedure. He spends an hour in the recovery room before being returned to the ward. You are called to see him and on examination note that he is drowsy, has shallow breathing, a slow pulse and pinpoint pupils. The notes show an uneventful anaesthetic using an inhalational agent, muscle relaxant and fentanyl. In the recovery room he was breathing normally and was awake, but because of pain was initially given intravenous morphine and then intramuscular morphine before being returned to the ward. Your course of action is:

Correct Answer: D

Rationale: The patient shows opioid overdose signs (drowsiness, respiratory depression, bradycardia, miosis) from fentanyl and morphine. Calling the resuscitation team delays specific treatment unless unresponsive. Atropine treats bradycardia but not respiratory depression. Neostigmine reverses neuromuscular blockers, not opioids. Flumazenil reverses benzodiazepines. IV naloxone, an opioid antagonist, rapidly reverses these effects, restoring breathing and consciousness, the best immediate action. Its specificity and speed are vital in postoperative opioid toxicity, ensuring patient safety.

Correct Answer: B

Rationale: Prazosin, an alpha-1 blocker, acts peripherally, not on the vasomotor center. Methyldopa, a centrally acting α2 agonist, reduces sympathetic outflow from the vasomotor center, a true statement lowering blood pressure. Hydralazine dilates arteries directly, not centrally. Reserpine depletes catecholamines peripherally and centrally but isn't primarily vasomotor-focused. Losartan (likely misspelled) is an ARB, peripheral. Methyldopa's central action is key in pregnancy hypertension, offering a unique mechanism among antihypertensives.

Correct Answer: B

Rationale: The nurse's best response would be, It takes 6 to 8 weeks to see a change in cholesterol levels. Statin drugs typically start to show an effect on lowering cholesterol levels within 6 to 8 weeks of starting therapy. It may take some time for the medication to reach its maximum effectiveness, but a noticeable change can usually be seen within this time frame. Monitoring cholesterol levels through blood tests is important to assess the effectiveness of the medication and make any necessary adjustments to the treatment plan.

Correct Answer: B

Rationale: Metformin is a first-line medication for the treatment of type 2 diabetes. Its primary pharmacological action is to decrease hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis in the liver. This helps to lower blood glucose levels. Metformin also increases insulin sensitivity in peripheral tissues like muscle and fat, allowing tissues to better respond to insulin and take up glucose from the blood. This dual mechanism of action makes metformin an effective medication for managing blood glucose levels in patients with type 2 diabetes.

Correct Answer: D

Rationale: Hallucinations, violence, hypertension, and hyperthermia suggest phencyclidine (PCP) overdose . PCP, an NMDA antagonist, causes dissociative psychosis and sympathetic stimulation. Alcohol sedates, cocaine lacks hallucinations, marijuana doesn't cause violence, and Quaaludes (E) sedate. PCP's unique profile fits this acute, agitated presentation.