A client calls the nurse help-line and says, 'My friend and I have been swimming and drinking beer all day and he took a couple of swigs of Robitussin DM (dextromethorphan) about 15 minutes ago. Now he is acting funny and seeing things.' What should the nurse consider when formulating a response?

Correct Answer: D

Rationale: Dextromethorphan with alcohol causes dizziness and hallucinations , guiding the nurse to advise medical help. Dialysis , opioid status , and addiction are incorrect. D informs the response, making it key.

Correct Answer: D

Rationale: Midazolam is a short-acting benzodiazepine widely used as an anesthetic due to its rapid onset and potent sedative effects. Its mechanism involves enhancing the activity of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain, at GABA_A receptors—not GABA_B receptors, which are linked to different effects like muscle relaxation. By binding to a specific site on the GABA_A receptor, midazolam increases the frequency of chloride channel opening, leading to greater chloride ion conductance into neurons. This hyperpolarizes the neuron, making it less excitable and producing sedation, anxiolysis, and anesthesia. Dopamine enhancement is unrelated to its action, as is NMDA receptor blockade, which is a feature of drugs like ketamine. Partial agonism at serotonin (5HT) receptors also does not apply here. The facilitation of GABA-mediated chloride conductance is the precise mechanism that underpins midazolam's clinical utility as an anesthetic agent.

Correct Answer: A

Rationale: Benzos (e.g., diazepam) in an 87-year-old with a cane raise fall risk-sedation and slow clearance heighten injury odds, per geriatrics. Kids rarely get benzos-alternatives exist. Adults (42, 32) handle them better unless dependent. Elderly frailty drives concern, a safety red flag.

Correct Answer: B

Rationale: Valproate is classified as an anti-convulsant medication. It is commonly used to treat seizures, particularly in the management of epilepsy. Valproate works by affecting certain chemicals in the brain to control seizures and stabilize mood in some psychiatric conditions. It is not classified as an anti-diabetic, anti-ulcer agent, or anti-hypertensive medication.

Correct Answer: A

Rationale: Vancomycin's red man syndrome-flushing during infusion-is non-hypersensitivity mast cell degranulation . Rapid infusion triggers histamine release, not IgE-mediated allergy . Type II , III , and IV (E) involve immune mechanisms unrelated to this acute, rate-dependent reaction. Slowing infusion prevents it, distinguishing it from true hypersensitivity, aligning with vancomycin's pharmacology in MRSA treatment.

Correct Answer: B

Rationale: Cyanocobalamin, or vitamin B12, is essential for red blood cell production and neurological function, and its deficiency directly leads to pernicious anemia, a condition characterized by large, immature red blood cells due to impaired DNA synthesis. This occurs because B12 is crucial for folate metabolism and erythropoiesis, and without it, anemia develops, often accompanied by neurological symptoms like numbness or tingling. Pellagra, however, results from niacin (vitamin B3) deficiency, manifesting as dermatitis, diarrhea, and dementia-unrelated to B12's role. Rickets stems from vitamin D deficiency, causing bone deformities due to poor calcium absorption, not a B12 issue. Scurvy arises from vitamin C deficiency, leading to collagen breakdown and symptoms like bleeding gums, distinct from B12's hematological effects. Pernicious anemia stands out as the correct outcome because B12 deficiency disrupts bone marrow function, and it often requires pharmacotherapy, such as B12 injections, especially if absorption is impaired (e.g., due to lack of intrinsic factor). This specificity eliminates other conditions, highlighting B12's unique role in blood and nerve health.

Correct Answer: B

Rationale: Heparin is an anticoagulant medication used to prevent blood clots. If a patient on heparin therapy experiences excessive bleeding or needs to quickly reverse the anticoagulant effects of heparin, the antidote is protamine sulfate. Protamine sulfate works by neutralizing the effects of heparin by forming a complex with it. It is important for healthcare providers to have protamine sulfate readily available when managing patients on heparin therapy to effectively reverse its anticoagulant effects in emergency situations.

Correct Answer: C

Rationale: A large-bore catheter is recommended for whole blood transfusions to allow for the rapid administration of blood products and to prevent hemolysis. Smaller catheters may not accommodate the viscosity of whole blood and could increase the risk of complications. While patient comfort and past experiences are important, the primary consideration is the safe and effective delivery of the transfusion. Therefore, a large-bore catheter is the best choice.

Correct Answer: A

Rationale: Simvastatin, a statin, lowers cholesterol by inhibiting HMG-CoA reductase, most active at night when synthesis peaks. Evening dosing optimizes efficacy. Grapefruit juice increases levels, risking toxicity. Stopping if normal risks rebound. Breakfast misses the cycle. Evening aligns with simvastatin's pharmacodynamics, key in hyperlipidemia where timing boosts results, making A the key instruction.