A patient who has been taking an antidepressant for 2 months shares with the nurse, “Since my depression is over, I’ve stopped the Prozac and I won’t need to see you any longer.” Which response by a nurse would be most therapeutic?

Correct Answer: A

Rationale: Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis. This is similar to patients who take antihypertensives or insulin. The patient’s statement alerts the nurse to set clear therapy goals that extend beyond medication assessment. Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued, but the nurse’s suggestion of tapering off the medication is a wise intervention for this patient, who seems impulsive about medication adherence. A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has. Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis. Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse’s impatience and a judgmental attitude toward the patient, and a laissez-faire response does not reflect a caring attitude. Withdrawal usually is not a problem for medications with a long half-life.

Correct Answer: D

Rationale: The correct answer is D) The medication should be given 4 to 6 hours before bedtime to diminish insomnia. Methylphenidate hydrochloride (Ritalin) is a CNS stimulant that can cause insomnia as a side effect. By giving the medication at bedtime, the child may experience difficulty falling asleep or disrupted sleep patterns. Administering the medication earlier in the day allows for its effects to wear off by bedtime, reducing the risk of insomnia. Option A is incorrect because giving the medication at bedtime is not appropriate due to the risk of insomnia. Option B is incorrect as medication timing should be based on pharmacokinetics and individual patient needs, not on location. Option C is incorrect as methylphenidate can be taken with or without food, and meal timing does not significantly impact its absorption. In an educational context, it is crucial for healthcare providers to understand the pharmacokinetics and side effects of medications to ensure safe and effective treatment. Educating parents and caregivers on proper medication administration can improve treatment outcomes and minimize potential risks for pediatric patients with ADHD.

Correct Answer: B

Rationale: Intravenous digitalis, such as digoxin, exerts a negative chronotropic effect by slowing down the heart rate. This is due to its action on the sinoatrial (SA) node, reducing the firing rate of the heart's natural pacemaker. This effect is evident in patients as a decreased heart rate, which is the correct answer (B). Option A, decreased blood pressure, is not directly related to the chronotropic effect of digitalis. While digitalis can indirectly impact blood pressure through its effects on cardiac output, the primary effect being tested in this question is the drug's chronotropic effect. Option C, decreased conduction, is more related to drugs affecting the conductivity of the heart's electrical system, such as antiarrhythmics, rather than digitalis, which primarily affects heart rate. Option D, decreased ectopic beats, is not a direct result of digitalis' negative chronotropic effect. Ectopic beats are abnormal heartbeats originating outside the SA node, and while digitalis can have antiarrhythmic properties, its primary chronotropic effect does not directly address ectopic beats. Understanding the effects of cardiovascular drugs, like digitalis, is crucial in nursing pharmacology to ensure safe and effective patient care. Nurses must be able to recognize and anticipate the specific impacts of medications on the cardiovascular system to monitor patients effectively and intervene if necessary.

Correct Answer: A

Rationale: There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

Correct Answer: B

Rationale: In the context of pharmacology, pharmacokinetics refers to the study of how the body processes a drug. The correct answer, B) The study of absorption, distribution, metabolism, and excretion of drugs, is right because it specifically focuses on the key processes involved in drug disposition within the body. Option A) The study of biological and therapeutic effects of drugs, is incorrect because it pertains more to pharmacodynamics, which involves understanding how drugs interact with the body to produce their effects. Option C) The study of mechanisms of drug action, is incorrect as it also falls under pharmacodynamics, dealing with how drugs exert their effects at a cellular or molecular level. Option D) The study of methods of new drug development, is incorrect as it refers to pharmacology research related to discovering and developing new drugs rather than specifically focusing on how drugs are processed within the body. Understanding pharmacokinetics is crucial for nurses as it helps in determining the appropriate dosing regimens, anticipating potential drug interactions, and assessing the impact of patient-specific factors on drug effectiveness and safety. It forms the basis for individualizing drug therapy to optimize patient outcomes.