A patient tells the nurse, “My doctor prescribed Paxil (paroxetine) for my depression. I assume I’ll have side effects like I had when I was taking Tofranil (imipramine).” The nurse’s reply should be based on the knowledge that paroxetine is a:

Correct Answer: D

Rationale: Rationale: 1. Paroxetine is categorized as an SSRI (Selective Serotonin Reuptake Inhibitor), not a tricyclic antidepressant like Tofranil. 2. SSRIs, such as Paxil, work by increasing serotonin levels in the brain to alleviate depression. 3. Selective norepinephrine reuptake inhibitors (Choice A) target norepinephrine, not serotonin. 4. Tricyclic antidepressants (Choice B) like Tofranil work differently from SSRIs. 5. MAO inhibitors (Choice C) are another class of antidepressants that inhibit monoamine oxidase, not serotonin reuptake.

Correct Answer: C

Rationale: The correct answer is C because acetaminophen is primarily metabolized in the liver. Patients with a history of liver disease may have impaired liver function, leading to decreased metabolism of acetaminophen and potential toxicity. Fever and headache are common indications for acetaminophen use and do not necessarily contraindicate its use. Peptic ulcer disease is not a contraindication for acetaminophen as it does not directly affect the gastrointestinal system.

Correct Answer: D

Rationale: The correct answer is D: Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active. Rationale: 1. In severe liver disease, the liver's ability to metabolize drugs can be compromised. 2. Captopril is not a prodrug, meaning it does not require liver metabolism to become active. 3. This characteristic of captopril is advantageous in liver disease as it avoids potential issues related to impaired liver metabolism. Summary: A: Captopril can cause first-dose hypotensive effects, so it is not the advantage for a patient with severe liver disease. B: Captopril can affect electrolyte levels, so it is not the advantage for a patient with severe liver disease. C: Captopril being a prodrug and requiring liver metabolism would be a disadvantage for a patient with severe liver disease.

Correct Answer: D

Rationale: The correct answer is D because when administering heparin subcutaneously, using a - to -inch 25- to 28-gauge needle is appropriate to ensure proper delivery into the subcutaneous tissue. This needle size is suitable for subcutaneous injections and helps prevent complications such as leakage or irritation. As for the other choices: A: Aspirating the syringe before injecting the medication is not necessary for subcutaneous injections as it is commonly done for intramuscular injections to ensure proper needle placement. B: Massaging the site after injection is not recommended as it can cause bruising or discomfort. C: Applying heat to the injection site is not a standard procedure for subcutaneous injections and may not provide any benefit in this context.

Correct Answer: C

Rationale: The correct answer is C: Obtain an order for a spacer device. This intervention is most appropriate as a spacer device can help improve the delivery of medication from the MDI, even if the patient is unable to coordinate inhalation with activation. The spacer device acts as an intermediary between the inhaler and the patient, allowing the medication to be inhaled more effectively. This ensures that the patient receives the full dose of the medication. Incorrect answers: A: Notifying the doctor that the patient is unable to use the MDI does not directly address the issue of coordination and does not provide a solution. B: Obtaining an order for a peak flow meter is not the most appropriate intervention in this scenario, as it does not address the patient's inability to coordinate the use of the MDI. D: Asking the prescriber if the medication can be given orally is not necessary if the patient can still benefit from using the MDI with the help of a spacer device.