A client is scheduled to receive methotrexate (Folex), 0.625 mg/kg P.O. daily, to treat malignant lymphoma. Before administering the drug, the nurse reviews the client’s medication history. Which of the following drugs might interact with methotrexate?

Correct Answer: B

Rationale: The correct answer is B: Probenecid (Benemid). Probenecid can increase methotrexate levels, leading to potential toxicity. Methotrexate is primarily eliminated by the kidneys, and Probenecid inhibits renal tubular secretion, causing methotrexate levels to rise. Digoxin (A), theophylline (C), and famotidine (D) do not have significant interactions with methotrexate. In summary, Probenecid is the correct answer as it can increase methotrexate levels through renal tubular secretion inhibition, while the other choices do not have a significant interaction with methotrexate.

Correct Answer: D

Rationale: The correct answer is D: Understands discharge instructions. This is crucial for patient safety and recovery post-surgery. Understanding discharge instructions ensures patients know how to care for themselves at home, manage medications, recognize warning signs, and follow-up instructions. Choice A is incorrect as patients should not drive after surgery due to potential impairment. Choice B is incorrect as IV narcotics administration timing is not a discharge criterion. Choice C is irrelevant to the patient's readiness for discharge. Understanding discharge instructions is the key factor in ensuring the patient's well-being and recovery after ambulatory surgery.

Correct Answer: D

Rationale: The correct answer is D: Platelet count. Zidovudine (AZT) is known to cause bone marrow suppression, leading to decreased platelet production. Monitoring platelet count is crucial to detect early signs of thrombocytopenia, a common adverse effect of AZT. Rationale: A) RBC count: AZT can cause anemia, not specifically affecting the RBC count. B) Serum calcium: AZT does not typically affect calcium levels. C) Fasting blood glucose: AZT can cause hyperglycemia, but fasting blood glucose monitoring is not as critical as monitoring platelet count for AZT therapy.

Correct Answer: D

Rationale: The correct answer is D: Hyperparathyroidism. This disorder is characterized by excessive secretion of parathyroid hormone, leading to increased calcium levels in the blood. The symptoms described in the question - bone pain, weakness, irritability, and depression - are all associated with hypercalcemia, a common manifestation of hyperparathyroidism. Additionally, the client's anorexia and increased urination can be attributed to the effects of hypercalcemia on the gastrointestinal and renal systems. Diabetes mellitus (choice A) involves high blood sugar levels and is not associated with the symptoms described. Hypoparathyroidism (choice B) is characterized by low levels of parathyroid hormone and calcium, leading to different symptoms such as muscle cramps and seizures. Diabetes insipidus (choice C) is a disorder of water balance characterized by excessive thirst and urination, not the symptoms presented in the question.

Correct Answer: D

Rationale: The correct answer is D because it involves collaboration with the client to validate their experience. It shows respect for the client's perspective and promotes open communication. Choice A is incorrect as it lacks client involvement. Choice B is incorrect as it focuses on the nurse's interpretation rather than the client's experience. Choice C is incorrect as it may come off as accusatory or judgmental, lacking empathy.

Correct Answer: D

Rationale: The correct answer is D because morphine helps in acute pulmonary edema by decreasing peripheral resistance, pulmonary capillary pressure, and transudation of fluid. Morphine causes vasodilation, reducing peripheral resistance, which helps redistribute blood flow to the periphery. It also reduces pulmonary capillary pressure by decreasing preload and afterload, leading to decreased fluid transudation into the alveoli. Choices A, B, and C individually do not cover all the effects of morphine in acute pulmonary edema, making them incorrect.

Correct Answer: A

Rationale: The correct answer is A (5 to 10 mcg/ml) because this range is typically considered therapeutic for phenytoin (Dilantin) for seizure control. Levels below 5 mcg/ml may be subtherapeutic, leading to inadequate seizure control. Levels above 10 mcg/ml can increase the risk of toxicity. Choices B, C, and D are incorrect because they are outside the optimal therapeutic range, leading to either ineffective treatment (B, C) or an increased risk of adverse effects (D). Monitoring drug levels helps ensure the medication's effectiveness while minimizing side effects.

Correct Answer: C

Rationale: The correct answer is C because firm skin turgor indicates adequate hydration, a key goal of fluid resuscitation in diarrhea management. Firm skin turgor reflects the body's fluid balance and hydration status. When fluid resuscitation is successful, the patient's skin turgor improves due to replenished fluid levels. Choices A, B, and D are incorrect as they do not directly assess hydration status or the effectiveness of fluid resuscitation. Passing formed stools, decrease in stool frequency, and absence of perianal burning may be positive outcomes in diarrhea management, but they do not specifically indicate successful fluid resuscitation.

Correct Answer: D

Rationale: The correct answer is D because Huntington's disease is a neurodegenerative disorder that presents with a triad of symptoms: abnormal involuntary movements (chorea), intellectual decline, and emotional disturbances. Abnormal involuntary movements are a hallmark feature, while cognitive decline and emotional disturbances are also commonly observed. Therefore, all three manifestations are typically present in individuals with Huntington's disease. Choices A, B, and C are incorrect because each of these symptoms alone does not encompass the full spectrum of clinical manifestations seen in Huntington's disease.