A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?

Correct Answer: A

Rationale: The correct answer is A: 10 minutes. Sodium nitroprusside is a potent vasodilator used in hypertensive emergencies. It has a rapid onset of action and short half-life. Infusing the maximum dose for a longer duration could lead to excessive hypotension. Therefore, it should be titrated carefully, usually starting with a lower dose and increasing gradually. In this case, the nurse should monitor the patient's response closely and adjust the dose as needed every 5-10 minutes. Choices B, C, and D are incorrect because they suggest longer infusion durations, which could pose a risk of severe hypotension and adverse effects.

Correct Answer: D

Rationale: The correct answer is D because a decrease in symptoms of tuberculosis, improved chest x-rays, and sputum cultures indicate a therapeutic response to antitubercular therapy. This shows that the medication is effectively treating the infection. A: The chronic cough being gone does not necessarily indicate a therapeutic response as other symptoms and tests need to be considered. B: Two consecutive negative PPD results do not directly correlate with the effectiveness of antitubercular therapy as they measure immune response, not treatment response. C: Increased tolerance to medication and fewer reports of adverse effects are positive outcomes but do not directly indicate the effectiveness of the antitubercular therapy.

Correct Answer: A

Rationale: The correct answer is A: Acetylation. In the second phase of biotransformation, conjugation reactions occur where a functional group is added to the drug molecule. Acetylation involves the addition of an acetyl group to the drug molecule, making it more water-soluble and easier to excrete. Reduction (B) typically occurs in the first phase, oxidation (C) can occur in both phases, and hydrolysis (D) usually occurs in the first phase as well. Therefore, acetylation is the most likely process to proceed in the second phase of biotransformation.

Correct Answer: A

Rationale: The correct answer is A because a good local anesthetic agent should not cause local irritation and tissue damage. Local anesthetics work by blocking nerve signals in a specific area, without causing harm to surrounding tissues. Choices B, C, and D are incorrect because systemic toxicity, fast onset, and long duration of action, and vasodilatation are all aspects that can be associated with local anesthetics but are not necessarily indicative of a poor local anesthetic agent.

Correct Answer: C

Rationale: Nicotine is the correct answer because it activates both muscarinic and nicotinic receptors. Nicotinic receptors are ligand-gated ion channels found at neuromuscular junctions and autonomic ganglia. Muscarinic receptors are G-protein coupled receptors found in various tissues. Lobeline primarily acts on nicotinic receptors, pilocarpine primarily acts on muscarinic receptors, and bethanechol primarily acts on muscarinic receptors. Therefore, nicotine is the only cholinomimetic that activates both receptor types.