A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?

Correct Answer: B

Rationale: The correct answer is B: "Take the bronchodilator inhaler first." The rationale for this instruction is that bronchodilators work by relaxing the muscles around the airways, allowing for easier breathing. Taking the bronchodilator first helps open up the airways, making it easier for the corticosteroid to reach deeper into the lungs and be more effective. If the corticosteroid is taken first, it may not reach the lower airways as effectively. Choice A is incorrect because taking the corticosteroid first may not optimize the effectiveness of both medications. Choice C is incorrect as it is important to take these inhalers in a specific order for optimal effect. Choice D is incorrect because the order of inhaler use can impact the effectiveness of the medications.

Correct Answer: D

Rationale: The correct answer is D: Synergism. When drugs are used in combination, synergism can occur where the combined effect is greater than the sum of their individual effects. This can lead to enhanced therapeutic benefits or increased adverse effects. Tolerance (A) is the body's reduced response to a drug over time. Tachyphylaxis (B) is a rapid decrease in response to a drug with repeated administration. Accumulation (C) refers to the build-up of a drug in the body due to insufficient elimination. Synergism (D) is the only choice that specifically addresses the interaction between drugs leading to enhanced effects.

Correct Answer: A

Rationale: Prilocaine is the correct answer as it can cause methemoglobinemia due to its metabolite o-toluidine. This metabolite oxidizes hemoglobin to methemoglobin, leading to reduced oxygen-carrying capacity. Procaine, lidocaine, and ropivacaine do not typically cause methemoglobinemia as they lack the metabolites responsible for this condition. So, prilocaine is the only local anesthetic among the choices that can lead to methemoglobinemia.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Atropine is a non-selective muscarinic antagonist, blocking all muscarinic receptor subtypes (M1, M2, and M3). This is due to its structure and mechanism of action, which allows it to bind and inhibit all types of muscarinic receptors. Atropine's broad action leads to its multiple effects, such as blocking parasympathetic stimulation and increasing heart rate. Choices A, B, and C are incorrect because atropine does not selectively target only one specific muscarinic receptor subtype.

Correct Answer: D

Rationale: Sympathetic stimulation involves the activation of the sympathetic nervous system. Norepinephrine is released from sympathetic nerve terminals, activating adrenoreceptors on postsynaptic sites. Additionally, the adrenal medulla releases epinephrine into the bloodstream. Therefore, all three choices (A, B, and C) are mechanisms through which sympathetic stimulation is mediated. Hence, the correct answer is D. The other choices (A, B, and C) are incorrect as they individually represent different aspects of sympathetic stimulation, but the correct answer encompasses all of them.