A patient suffering from generalized anxiety disorder (GAD) has a history of drug dependence that includes the illicit use of secobarbital ('reds') and a variety of other drugs. Psychotherapy is indicated, but the physician also prescribes a drug that can be helpful in GAD and that has the advantage of no abuse liability. The drug prescribed was most likely to have been

Correct Answer: B

Rationale: Buspirone, a 5HT1A partial agonist, treats GAD by modulating serotonin without sedative or euphoric effects, making it ideal for patients with substance abuse histories like secobarbital (a barbiturate). It lacks abuse potential, unlike benzodiazepines, and doesn't cause dependence, aligning with the patient's needs. Bupropion, an NE/DA reuptake inhibitor, targets depression and smoking cessation, not GAD, and has stimulant-like risks. Baclofen, a GABA_B agonist, manages spasticity, not anxiety, and has some abuse potential. Buprenorphine, an opioid partial agonist, treats addiction but not GAD and carries dependence risk. Phenobarbital, a barbiturate, mirrors the patient's abuse history and is contraindicated. Buspirone's efficacy in GAD, non-addictive nature, and safety in this context make it the optimal choice.

Correct Answer: A

Rationale: When a patient taking high-dose aspirin for arthritis requires prednisone for an acute flare, the nurse should be aware that prednisone can increase blood glucose levels. As such, the nurse should monitor the patient for signs and symptoms of hyperglycemia, not hypoglycemia. It is essential to closely monitor the patient's blood glucose levels to prevent complications associated with high blood sugar levels, such as hyperglycemia. It is also crucial to educate the patient about the potential side effects of prednisone and instruct the patient on how to manage blood glucose levels while taking the medication.

Correct Answer: C

Rationale: In chemical antagonism, two drugs produce opposite effects on a physiological system but do not act at the same receptor site. This type of antagonism occurs when one drug chemically interacts with another drug to reduce its effects. The drugs involved in chemical antagonism do not compete for the same receptor site, unlike competitive antagonism where drugs compete for the same receptor site, or noncompetitive antagonism where drugs may act at different sites but still result in inhibition. Physiological antagonism involves two drugs that produce opposite effects but do not necessarily interact chemically. Potentiation refers to the increase in effect when two drugs are combined. Given the scenario described in the question, the phenomenon of two drugs producing opposite effects without acting at the same receptor site best aligns with chemical antagonism.

Correct Answer: A

Rationale: Monitor vital signs and assess cardiovascular status including pulse, blood pressure, and cardiac output to evaluate for possible cardiac effects. Although assessment of bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels may be important to patient care, they are not related to administration of a nonselective adrenergic blocking agent. The nurse should prioritize cardiovascular assessments to ensure patient safety.

Correct Answer: B

Rationale: Sympathomimetic amines are compounds that mimic the effects of the sympathetic nervous system. Options A, C, D, and E (epinephrine, norepinephrine, levonordefrin, and phenylephrine) are all sympathomimetic amines commonly used in dentistry for their vasoconstrictive properties. Felypressin, on the other hand, is a synthetic vasopressin analog and does not have sympathomimetic properties. It is commonly used in dentistry as a local vasoconstrictor to prolong the anesthetic effect.

Correct Answer: C

Rationale: Phenytoin (Dilantin) belongs to the therapeutic class of anticonvulsants. Anticonvulsants are medications primarily used to treat and prevent seizures and are commonly prescribed for patients with epilepsy. Phenytoin works by stabilizing the electrical activity in the brain to prevent abnormal brain activity that leads to seizures. It is not classified as a mood stabilizer or bronchodilator; its main purpose is to control epileptic seizures.

Correct Answer: D

Rationale: Weight loss, tachycardia, and goitre suggest hyperthyroidism (e.g., Graves'). Verapamil controls rate but not thyroid function. Radioactive iodine (131I) treats long-term, not immediately. Carbamazepine is for seizures, L-thyroxine worsens hyperthyroidism. Atenolol, a beta-blocker, immediately reduces tachycardia and symptoms by blocking adrenergic effects, suitable for acute management while awaiting antithyroid drugs (e.g., propylthiouracil). Its symptomatic relief is critical in hyperthyroid crises.

Correct Answer: C

Rationale: Drug B, as an inducer of the cytochrome p-450 system, increases the metabolism of Drug A, leading to lower plasma concentrations and reduced therapeutic effects of Drug A. This interaction is a common concern in polypharmacy, where one drug affects the metabolism of another. Monitoring for decreased efficacy of Drug A is essential to ensure the patient receives adequate treatment. Increased adverse effects of Drug B or decreased effects of Drug B are less likely in this scenario.

Correct Answer: A

Rationale: Amitriptyline, a tricyclic antidepressant, typically requires 2 to 6 weeks to achieve full therapeutic effect, as it gradually increases neurotransmitter levels (e.g., serotonin, norepinephrine) in the brain to alleviate depression. After only 2 weeks, the patient's continued symptoms are expected, not indicative of failure, making choice A the best response: it educates the patient on the timeline, fostering adherence. Choice B dismisses the patient's feelings with subjective reassurance, undermining trust. Choice C prematurely suggests switching drugs without evidence, risking unnecessary changes. Choice D exaggerates the timeline to months, which is inaccurate and discouraging. The nurse's role is to provide accurate information and support, reinforcing that delayed onset is normal for this class of medication, thus making choice A the most therapeutic and evidence-based response.