A 66-year-old man with a history of recurrent pulmonary infections and hypertension is managed with ethacrynic acid, which controls his hypertension well. He is often hospitalized and placed on gentamicin for his recurrent pulmonary infections. Which of the following adverse effects must the treating physician be keenly aware of?

Correct Answer: B

Rationale: Gentamicin, an aminoglycoside, risks ototoxicity-hearing loss , especially with repeated use. Ethacrynic acid, a loop diuretic, also has ototoxicity potential, compounding risk. Dizziness , nausea , vertigo , and vomiting (E) occur but are less specific. Monitoring hearing is critical in this scenario.

Correct Answer: C

Rationale: Typical antipsychotics block dopamine D2 receptors, causing extrapyramidal symptoms (EPS) like parkinsonism due to dopamine-acetylcholine imbalance in the basal ganglia. Drugs alleviating EPS often restore this balance. Drug A strongly activates dopamine receptors, mimicking dopamine and potentially countering the blockade, but excessive activation risks psychosis. Drug B moderately boosts dopamine and GABA, offering some benefit but less specificity. Drug C potently blocks muscarinic acetylcholine receptors, reducing cholinergic overactivity that emerges from dopamine depletion, a well-established approach (e.g., benztropine) for EPS relief without worsening psychosis. Drug D enhances GABA, unrelated to EPS mechanisms. Drug E mildly activates dopamine and GABA, insufficient for robust relief. Blocking muscarinic receptors directly addresses the cholinergic excess, making it the most effective and clinically validated strategy for EPS management.

Correct Answer: A

Rationale: Penicillin is a commonly used antibiotic for infections like sinusitis, but its safety profile must be assessed, especially in female clients of reproductive age. The priority question is whether the client is pregnant because penicillin is classified as a Category B drug by the FDA, meaning it's generally considered safe during pregnancy, but confirmation of pregnancy status is critical to ensure no unforeseen risks or contraindications exist, such as hypersensitivity. Pregnancy also affects drug metabolism and dosing considerations, making this the most immediate concern. Asking about plans to become pregnant is less urgent, as it pertains to future rather than current status. Breastfeeding is important due to potential drug excretion in milk, but it's secondary to confirming current pregnancy. Birth control pills might interact with some antibiotics (though less so with penicillin), but this is not the primary safety concern. Thus, choice A is the priority question to ensure safe administration.

Correct Answer: A

Rationale: Vancomycin, a glycopeptide antibiotic, is critical for treating MRSA but carries risks of hypersensitivity reactions (e.g., rashes) and nephrotoxicity (e.g., reduced urine output). The nurse's priority when observing an upper body rash and decreased urine output is to hold the next dose and notify the physician . This action prevents further drug administration that could worsen a potential allergic reaction or kidney damage, both serious adverse effects requiring immediate medical evaluation. An X-ray might assess lung involvement in severe cases but isn't the first step for these symptoms. An antihistamine could treat mild itching but risks masking a systemic reaction, delaying critical care. A urine specimen might confirm renal issues but doesn't address the urgency of stopping the drug. Holding the dose ensures patient safety while awaiting physician guidance, aligning with nursing protocols for adverse drug reactions, making A the most prudent and timely action.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.