Select all the early manifestations of lithium

Correct Answer: A

Rationale: Nausea is one of the early manifestations of lithium toxicity. It is important to monitor for this symptom in patients taking lithium to detect toxicity early and prevent more serious complications. Hypotension and renal failure are more severe manifestations of lithium toxicity that occur at later stages. Muscle weakness is not typically associated with early lithium toxicity.

Correct Answer: D

Rationale: These drugs are generally safe during breastfeeding, with minimal risk of transfer to the infant.

Correct Answer: D

Rationale: Trastuzumab is a targeted therapy used specifically for HER2-positive breast cancer. If the patient's cancer cells do not overexpress the HER2 receptor, trastuzumab will not be effective. The decision to use targeted therapy is based on the molecular characteristics of the tumor, not the patient's age, insurance coverage, or estrogen receptor status. The nurse should explain that targeted therapies are tailored to the specific biology of the cancer, and trastuzumab is only appropriate for HER2-positive tumors.

Correct Answer: D

Rationale: Heparin is an anticoagulant that enhances the activity of antithrombin III, a natural inhibitor of thrombin and factor Xa, to prevent clotting. The statement that it inhibits clotting by decreasing antithrombin III effects is false, as heparin actually potentiates antithrombin III, making this the incorrect option. Its oral bioavailability is negligible (not 20-30%), as it's a large polysaccharide requiring parenteral administration (e.g., IV or subcutaneous), so this is false. Heparin is highly plasma protein-bound, not low, contradicting that option. The correct statement, replaced in the fourth slot, is that heparin binds to antithrombin III, causing a conformational change that accelerates its anticoagulant effect. This mechanism is fundamental to its clinical use in thrombosis prevention, distinguishing it from oral anticoagulants like warfarin.

Correct Answer: B

Rationale: - Tachycardia (increased heart rate) can be an adverse effect of amiodarone. This medication is used to treat irregular heartbeats, so it's important to monitor for any abnormal heart rhythms, including tachycardia.

Correct Answer: A

Rationale: Penicillin is inactivated by erythromycin. Penicillin is a beta-lactam antibiotic which acts by inhibiting cell wall synthesis in bacteria. However, erythromycin is a macrolide antibiotic which can inactivate beta-lactam antibiotics like penicillin. When given together, erythromycin can inactivate penicillin, reducing its efficacy and potentially leading to treatment failure. Therefore, it is not appropriate to use both penicillin and erythromycin simultaneously to treat a bacterial infection.

Correct Answer: D

Rationale: Depo-Provera lasts 3 months , inhibiting ovulation via progestin. Two months underestimates, six months and one year overestimate. D provides accurate timing, ensuring adherence, making it the best response.

Correct Answer: D

Rationale: Nalbuphine is an opioid agonist-antagonist used for pain management. Like other opioids, it can cause respiratory depression, so monitoring respirations is critical. Bradycardia is another potential side effect that patients should report. Administering nalbuphine undiluted is not standard practice, as it can increase the risk of adverse reactions. Excessive urine output is not associated with nalbuphine use. Therefore, the nurse should focus on monitoring respirations and educating the patient to report bradycardia.

Correct Answer: C

Rationale: Thiopental, a barbiturate, persists 24 hours post-surgery. Physiologic metabolism is correct-its lipophilicity causes redistribution to fat, with slow hepatic metabolism, normal in the elderly. Hepatitis or insufficiency lacks evidence. Renal failure doesn't primarily clear it. Trauma (E) is unrelated. This reflects thiopental's pharmacokinetics, not pathology.