During a home visit with a patient diagnosed with schizophrenia the patient tells the community health nurse, “I’m going to stop going to the clinic for my fluphenazine decanoate (Prolixin) shots because I think I’m okay now.” Which statement represents the best understanding of the effect of the patient’s decision on the prognosis?

Correct Answer: A

Rationale: The correct answer is A because it demonstrates therapeutic communication and empathy by acknowledging the patient's perspective and inviting further discussion. By exploring the patient's reasons for wanting to stop the medication, the nurse can address underlying concerns and provide education on the importance of medication adherence in managing schizophrenia. Choice B is incorrect as it undermines the patient's autonomy and fails to address the patient's reasons for stopping the medication. Choice C is partially correct in acknowledging the patient's perspective but lacks the active engagement needed to assess and address the patient's decision. Choice D is incorrect as it expresses fear without exploring the patient's beliefs and reasons, which can lead to resistance and non-compliance.

Correct Answer: D

Rationale: The correct answer is D: “My mouth has been so dry lately.” This statement indicates the patient is experiencing xerostomia, a common adverse effect of phenothiazines due to their anticholinergic properties. Xerostomia results in decreased salivary flow, leading to dry mouth. Choices A, B, and C are less likely to be related to phenothiazine use. A is a common symptom of schizophrenia, B could indicate increased appetite which is not a common side effect, and C is not a typical side effect of phenothiazines.

Correct Answer: B

Rationale: The correct answer is B: Acutely decompensated heart failure with dyspnea at rest. Nesiritide (Natrecor) is a medication used specifically for the treatment of acutely decompensated heart failure with dyspnea at rest. This medication helps to reduce cardiac filling pressures and improve symptoms in patients experiencing acute exacerbation of heart failure. Choices A, C, and D are incorrect because nesiritide is not indicated for these conditions. Atrial fibrillation (Choice A) is a cardiac arrhythmia, systolic heart failure (Choice C) involves impaired heart muscle contraction, and long-term treatment of heart failure (Choice D) typically involves different medications like ACE inhibitors, beta-blockers, and diuretics.

Correct Answer: C

Rationale: The correct answer is C because dextromethorphan suppresses the cough reflex by directly acting on the cough center in the brain. This drug inhibits the signals that trigger the cough reflex, leading to reduced coughing. Choice A is incorrect as dextromethorphan does not depress the central nervous system like opioids. Choice B is incorrect because dextromethorphan does not anesthetize stretch receptors. Choice D is incorrect as dextromethorphan does not affect the viscosity of bronchial secretions.

Correct Answer: C

Rationale: The correct answer is C because bioavailability is determined by the extent of absorption and hepatic first-pass effect. Absorption refers to how much of a substance is taken up by the body, while the hepatic first-pass effect is the initial metabolism of a drug in the liver before it reaches systemic circulation. These factors directly impact the amount of a substance that is available to produce its desired effect. Rheological parameters of blood (A) are unrelated to bioavailability. The amount of a substance obtained orally and quantity of intakes (B) may affect bioavailability indirectly but do not determine it. Glomerular filtration rate (D) is related to renal excretion, not bioavailability.