A client reports taking Phenylephrine nasal drops for the past 10 days for Sinusitis. The nurse should assess the client for which of the following adverse effects of this medication?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Nasal congestion. Phenylephrine is a nasal decongestant commonly used to relieve nasal congestion associated with conditions like sinusitis. By constricting blood vessels in the nasal passages, it reduces swelling and congestion, making breathing easier for the individual. Option A) Sedation is incorrect because phenylephrine is a sympathomimetic drug that typically causes stimulation rather than sedation. Option C) Productive cough is incorrect as phenylephrine does not typically cause cough but rather acts to alleviate nasal congestion. Option D) Constipation is also incorrect as this is not a common adverse effect associated with phenylephrine nasal drops. Educationally, understanding the mechanism of action of phenylephrine helps students grasp why nasal congestion is the most relevant adverse effect to assess for in a client using this medication. It also highlights the importance of knowing the expected side effects of common medications to provide safe and effective care to patients.

Correct Answer: C

Rationale: The correct answer is C: Delirium. When IV nitroprusside is administered at high dosages, it can lead to thiocyanate toxicity, resulting in mental status changes such as delirium. Monitoring thiocyanate levels during therapy is crucial to ensure they remain below 10 mg/dL to prevent this adverse reaction.

Correct Answer: B

Rationale: In case anginal pain persists after taking the first tablet and waiting 5 minutes, the priority step is to call emergency services (911) and then take a second sublingual tablet. Persistent pain could indicate a myocardial infarction, and immediate medical attention is crucial. If the pain continues even after the second tablet, the client can take a third tablet after an additional 5-minute wait.

Correct Answer: A

Rationale: In this situation, where the client's blood pressure is significantly lowered due to Verapamil administration, the nurse should anticipate a prescription for Calcium gluconate. Calcium gluconate is used to reverse severe hypotension caused by Verapamil. It should be given slowly intravenously as it counteracts the vasodilation caused by Verapamil, helping to normalize blood pressure levels.

Correct Answer: D

Rationale: The correct answer is D) Take colesevelam with food and at least one glass of water. Rationale: - Colesevelam is a bile acid sequestrant that works by binding to bile acids in the intestine, which can interfere with the absorption of other medications like digoxin. Taking colesevelam with food and water helps to prevent drug interactions and ensures proper absorption of both medications. Incorrect options: - Option A is incorrect because digoxin should not be taken with colesevelam due to the risk of decreased absorption. - Option B is not directly related to the interaction between digoxin and colesevelam. - Option C is unrelated to the instructions for taking colesevelam and does not address the potential drug interaction. Educational context: It is crucial for nurses to understand the potential drug interactions and instructions for administration of medications to ensure patient safety and treatment efficacy. Teaching patients about the proper administration of medications like colesevelam is essential to prevent complications and maximize therapeutic benefits.