A patient who is a recovering alcoholic has been diagnosed as having panic attacks. The psychiatrist mentions plans to treat the patient with daily doses of medication. Of the medications listed below, for which drug should the nurse plan patient teaching?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Paroxetine (Paxil). Paroxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat panic attacks and other anxiety disorders. The rationale for choosing Paroxetine for patient teaching lies in its mechanism of action and suitability for a recovering alcoholic. Unlike benzodiazepines such as Alprazolam (B) which can be habit-forming and have a high potential for abuse, SSRIs like Paroxetine are non-addictive and safe for individuals with a history of substance abuse. Educating the patient about the importance of taking Paroxetine consistently, understanding its delayed onset of action, and potential side effects is crucial for treatment success. Alprazolam (Xanax) (B) is not the ideal choice for a recovering alcoholic due to its addictive nature and potential for abuse. Chlorpromazine (Thorazine) (C) is an antipsychotic medication not typically used for panic attacks. Propranolol (Inderal) (D) is a beta-blocker that can be effective for performance anxiety but is not the first-line treatment for panic attacks. In an educational context, understanding the rationale behind choosing the appropriate medication for a specific patient scenario is vital for nursing practice. It emphasizes the importance of considering factors such as past medical history, substance abuse, and pharmacological mechanisms when selecting the most appropriate treatment option for patients.

Correct Answer: A

Rationale: This question requires analytical decision making to identify hypertensive crises and data for the evaluation process. Knowing when the last dose of the monoamine oxidase inhibitor (MAOI) was taken helps determine immediate treatment. Although the ingestion of alcohol is pertinent to determining what tyramine-containing foods the patient may have had, it is not as crucial as knowing when the last dose of MAOI was consumed. Although natural foods may produce similar bioactivity and other antidepressants should not be taken along with an MAOI, these answers do not reflect medication assessment and evaluation. The patient is experiencing the clinical manifestation of hypertensive crisis. The classic symptoms of this condition are severe occipital headache, dilated pupils, hypertension, and palpitations or arrhythmias. This syndrome can be caused when the patient who is taking an MAOI ingests food containing tyramine, an amino acid released from foods that undergo hydrolysis (e.g., fermentation, aging, pickling, smoking, spoilage). This inhibits the monoamine oxidase and allows tyramine to reach the adrenergic nerve endings and cause the release of excess norepinephrine, which causes hypertensive crisis. To confirm the physical syndrome, first determine whether the patient is taking an MAOI. Knowing when the last dose was ingested provides a window for the duration of hypertension and therapeutic nursing interventions.

Correct Answer: D

Rationale: In the context of pharmacology, understanding the anatomy and physiology of the neurologic system is crucial for nurses, including psychiatric nurses. The correct answer, option D, states that it is necessary for planning psychiatric care. This is because many psychiatric medications act on the central nervous system and understanding neuroanatomy helps in comprehending how these drugs work, their side effects, and potential interactions. Option A is incorrect because even psychiatric nurses need a solid foundation in neuroanatomy to provide holistic care. Option B is inaccurate as nurses do utilize neurologic principles in their practice, especially when administering medications affecting the nervous system. Option C is also incorrect as knowledge of neuroanatomy is vital not just for assessment but also for developing effective and safe treatment plans. Educationally, grasping neuroanatomy enhances a nurse's ability to assess, intervene, and educate patients effectively. It allows for a deeper understanding of drug actions, adverse effects, and patient responses, leading to improved patient outcomes and safety. Therefore, integrating neurologic concepts into nursing education is essential for developing competent and knowledgeable nurses.

Correct Answer: A

Rationale: In the context of pharmacology, understanding the implications of caffeine use in different medical conditions is crucial for safe and effective patient care. In this scenario, the correct answer is A) A history of peptic ulcers. Caffeine is known to stimulate gastric acid secretion, which can exacerbate peptic ulcers or increase the risk of developing ulcers in individuals with a history of this condition. Therefore, caution is warranted when advising patients with peptic ulcers regarding caffeine consumption. Regarding the incorrect options: B) Migraine headaches: Caffeine is actually used in some headache medications due to its vasoconstrictive properties that can help alleviate headaches. C) Asthma: While caffeine can act as a bronchodilator, it is not generally contraindicated in asthma. D) A history of kidney stones: Caffeine intake is not typically associated with an increased risk of kidney stones formation. Educationally, this question highlights the importance of considering a patient's medical history and potential drug interactions when recommending caffeine use. It underscores the need for healthcare providers to be aware of how caffeine can impact various health conditions to provide safe and personalized care to their patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Withhold the dose, and notify the prescriber. Digoxin is a drug that directly affects the heart by increasing the strength of the heart muscle contractions. A low heart rate (bradycardia) such as 53 beats/minute in a patient about to receive digoxin can be a sign of digoxin toxicity. Administering the dose in this situation could exacerbate the toxicity and lead to serious cardiac complications like arrhythmias or even cardiac arrest. Option A is incorrect because administering the dose without addressing the low heart rate could be harmful to the patient. Option B is also incorrect because simply notifying the prescriber without taking immediate action to withhold the dose could result in a delay in necessary intervention. Option C, checking the radial pulse, is not the most appropriate action in this situation as the apical pulse is a more accurate reflection of the heart rate and its irregularities. From an educational perspective, this scenario highlights the importance of assessing vital signs before administering medications, especially those that directly affect cardiac function. It also emphasizes the significance of recognizing signs of potential medication toxicity and the need for prompt action to ensure patient safety. Healthcare providers must be vigilant in monitoring patients receiving medications with narrow therapeutic indices like digoxin to prevent adverse events.