A patient taking sunitinib reports that the skin on the hands and feet is red, painful, and has some blisters. Which action is appropriate for the nurse to take?

Correct Answer: D

Rationale: Sunitinib, a multikinase inhibitor, can cause hand-foot syndrome, a condition characterized by redness, pain, and blistering on the palms and soles. This side effect can be severe and may require dose adjustments or treatment interruptions. The nurse should notify the oncologist to evaluate the severity of the symptoms and determine if a dosage reduction is necessary. While protective measures like wearing gloves can help, they are not sufficient if the symptoms are severe. Documentation alone is inadequate for managing this potentially debilitating side effect.

Correct Answer: C

Rationale: A comprehensive drug history includes information about the patient's current and past medication use, including over-the-counter drugs, herbal supplements, and non-pharmacological pain relief methods. Asking, 'When you have pain, what do you do to relieve it?' provides insight into the patient's self-management strategies and helps identify potential drug interactions or misuse. While questions about sleeping pills, family history, and childhood diseases are relevant, they do not provide as much information about the patient's current medication practices. Therefore, focusing on pain relief methods is the most effective way to gather a detailed drug history.

Correct Answer: A

Rationale: 0.9 percent sodium chloride (normal saline) is the standard solution used to flush IV devices before and after blood transfusions. It is isotonic and compatible with blood products, preventing hemolysis or clotting. Dextrose solutions and sterile water are not used because they can cause hemolysis of red blood cells. Heparin sodium is used for maintaining patency in certain IV lines but is not suitable for blood transfusions. Therefore, normal saline is the correct choice for flushing IV devices in this context.

Correct Answer: D

Rationale: Hyperkalemia involves elevated potassium, hypokalemia reduced levels. Amphotericin causes hypokalemia via renal potassium wasting, not hyperkalemia. Prednisolone, a glucocorticoid, promotes potassium excretion, risking hypokalemia. Low molecular weight heparin (LMWH) rarely affects potassium directly with normal eGFR. Salmeterol, a beta-agonist, can shift potassium intracellularly, causing hypokalemia. Insulin, in diabetes management, drives potassium into cells with glucose, potentially causing hyperkalemia if renal excretion is impaired, though less common with normal eGFR. However, its potassium-shifting effect makes hyperkalemia more likely than hypokalemia compared to others, especially in acute settings, a key consideration in diabetic care.

Correct Answer: C

Rationale: Tricyclic antidepressants (TCAs) like amitriptyline have a high volume of distribution due to lipophilicity, not low, making that false. They're not useful in urinary retention (they cause it as a side effect) but are effective for chronic pain via monoamine modulation, so that's partially false. They can prolong the QT interval by blocking cardiac sodium channels, a true statement and significant risk factor for arrhythmias. They don't block monoamine oxidase (MAO) but inhibit reuptake of norepinephrine and serotonin, increasing synaptic levels, so that's false. They treat severe depression, even with suicidal ideation, though caution is needed. The QT prolongation is a critical electrophysiological effect, requiring ECG monitoring in clinical use to prevent torsades de pointes.