A patient diagnosed with cancer is scheduled to receive vincristine. Which nursing assessment will have the highest priority when providing care for this patient?

Correct Answer: D

Rationale: Vincristine is known to cause peripheral neuropathy, a common and potentially debilitating side effect. The nurse should prioritize assessing for signs of neuropathy, such as tingling, numbness, or weakness in the extremities. Alopecia, while distressing, is not as critical as neuropathy, which can affect the patient's mobility and quality of life. Vincristine does not typically cause significant changes in digoxin or phenytoin levels, making these assessments less relevant. Early detection of neuropathy allows for dose adjustments or supportive interventions to minimize long-term damage.

Correct Answer: A

Rationale: The patient's symptoms—cold, clammy skin, bradycardia, respiratory depression, and constricted pupils—are classic signs of opioid overdose. Naloxone is the antidote for opioid overdose and should be administered immediately to reverse the life-threatening effects of morphine. Meloxicam, pentazocine, and propoxyphene are not appropriate in this situation. Nurses must recognize the signs of opioid toxicity and act quickly to administer naloxone, ensuring the patient's airway, breathing, and circulation are supported.

Correct Answer: A

Rationale: Aplastic anemia is the most severe form of bone marrow toxicity, characterized by pancytopenia and bone marrow failure. It can be life-threatening and requires immediate intervention. Thrombocytosis, leukocytosis, and granulocytosis are not typically associated with drug-induced bone marrow toxicity.

Correct Answer: D

Rationale: Elimination half-life measures how quickly a drug is cleared from plasma. Naloxone's half-life is about 1-2 hours, used for opioid reversal. Morphine's is 2-4 hours, reflecting its duration as an analgesic. Methadone's is long, 15-60 hours, suiting addiction maintenance. Fentanyl's is 2-4 hours, typical for anesthesia. Remifentanil, an ultra-short-acting opioid, has a half-life of 3-10 minutes due to rapid esterase metabolism, making it ideal for procedures needing quick offset. Its brevity contrasts with others, ensuring minimal residual effects, a key advantage in critical care settings where rapid recovery is essential.

Correct Answer: C

Rationale: Adrenaline, or epinephrine, is a catecholamine that exerts its effects through adrenergic receptors, which are G-protein-coupled, making its action via G-proteins a true statement. Alpha receptor stimulation typically inhibits adenylate cyclase, reducing cyclic AMP (cAMP) production, which aligns with its known pharmacology and is also true. Adrenaline can indeed be administered via inhalation (e.g., for asthma), orally (though less common), and parenterally (e.g., intramuscularly in anaphylaxis), confirming this as true. However, adrenaline does have active metabolites, such as metanephrine and normetanephrine, produced via catechol-O-methyltransferase (COMT) metabolism, making the statement about having no active metabolites false. In cardiac arrest, it facilitates CPR by causing peripheral vasoconstriction, increasing coronary perfusion pressure, which is true. The false statement here is about the absence of active metabolites, as adrenaline's breakdown products retain some activity, a key point in understanding its pharmacokinetics and duration of effect.