The nurse in charge must monitor a patient receiving chloramphenicol for adverse drug reaction. What is the most toxic reaction to chloramphenicol?

Correct Answer: D

Rationale: Chloramphenicol is an antibiotic reserved for serious infections due to its potential for severe toxicity, with bone marrow suppression (Choice D) being the most dangerous adverse reaction. This condition can manifest as aplastic anemia, a potentially fatal reduction in blood cell production, affecting red cells, white cells, and platelets. The risk arises because chloramphenicol inhibits protein synthesis in bone marrow mitochondria, leading to suppressed hematopoiesis. Lethal arrhythmias (Choice A) are not a primary concern with this drug, as it doesn't directly affect cardiac ion channels. Malignant hypertension (Choice B) is unrelated, as chloramphenicol doesn't influence vascular tone or blood pressure significantly. Status epilepticus (Choice C), a prolonged seizure state, is also not associated, as the drug's neurotoxicity is more likely to cause peripheral neuropathy than seizures. Bone marrow suppression can lead to life-threatening infections, bleeding, or anemia, requiring close monitoring (e.g., regular complete blood counts). Its severity and irreversibility in some cases make it the most toxic reaction, confirming Choice D as the correct answer.

Correct Answer: B

Rationale: A blood pressure cuff too small for a client's arm compresses the brachial artery excessively, requiring higher inflation pressure to occlude it, resulting in a false-high measurement (Choice B). The cuff's bladder should encircle 80% of the arm; if undersized (e.g., adult cuff on an obese arm), it overestimates systolic and diastolic readingse.g., 150/90 mmHg might read 160/100 mmHg. Failing to show changes (Choice A) isn't the issue; the reading is inaccurate, not unresponsive. Sciatic nerve damage (Choice C) is unrelated, as the sciatic nerve is in the leg, not arm. A false-low measurement (Choice D) occurs with an oversized cuff, the opposite problem. Studies (e.g., AHA guidelines) confirm small cuffs inflate unevenly, skewing results high. Proper sizing prevents misdiagnosis like hypertension, making Choice B the correct effect.

Correct Answer: D

Rationale: Jugular vein distention (JVD)visible neck vein bulgingindicates elevated central venous pressure, typically from fluid overload (Choice D). This occurs when excess volume (e.g., heart failure, IV overload) backs up into the venous system, distending the jugular veins. Chest pain and shortness of breath align with this, suggesting cardiac strain (e.g., right heart failure). A neck tumor (Choice A) might compress veins, but JVD requires systemic pressure, not local obstruction, and lacks respiratory symptoms. Electrolyte imbalance (Choice B) affects cellular function, not directly venous pressure. Dehydration (Choice C) collapses veins, opposite to JVD. For example, in congestive heart failure, fluid retention raises venous return, causing JVD, detectable at 45° elevation. Fluid overload's pathophysiology fits the presentation, making Choice D the correct cause.

Correct Answer: C

Rationale: The circadian cycle orchestrates sleep via physiological shifts, notably lowering body temperature (by ~1°C) and releasing 'melatonin' from the pineal gland at dusk, signaled by the suprachiasmatic nucleus (SCN). Melatonin promotes drowsinesse.g., levels rise from 10 pg/mL daytime to 100 pg/mL at nightaligning sleep with darkness. 'Neonephrine' is fictitious; norepinephrine, if meant, promotes arousal, not sleep. 'Seratonin' , likely a misspelling of serotonin, aids mood and melatonin synthesis but isn't directly released for sleep onset. 'Dopamine' drives wakefulness and reward, peaking daytimee.g., its suppression at night aids sleep. For example, a nurse might note a patient's melatonin spike at 10 p.m., cooling their core temperature, per Taylor's circadian biology. Choice C is the correct chemical, critical for sleep preparation.

Correct Answer: A

Rationale: Stimulus control reconditions the bedroom as a sleep cue, per CBT-I protocols. 'Use the bedroom for sleep and sex only' is correct; limiting activitiese.g., no TV or workstrengthens the bed-sleep link, cutting sleep latency (e.g., from 40 to 15 minutes). Choice B, 'use the bedroom for reading and eating,' undermines this; multi-use (e.g., snacking at 10 p.m.) signals wakefulness, per sleep science. Choice C, 'go to bed at the same time every night,' is sleep hygiene, not stimulus control's coree.g., it's complementary, not defining. Choice D, 'sleep alone with minimal coverings,' is irrelevant; company or blankets don't dictate conditioning unless disruptive. For example, a patient leaving the bedroom if awake >20 minutes reinforces sleep association, per Taylor's behavioral approach. Choice A is the precise, correct recommendation.