The nurse is caring for a client receiving amitriptyline (Elavil) for depression. Which assessment finding requires immediate attention?

Correct Answer: C

Rationale: Amitriptyline, a tricyclic antidepressant, has anticholinergic effects, including urinary retention , a medical emergency risking bladder damage or infection, needing immediate intervention. Dry mouth and constipation are common, manageable side effects. Drowsiness is expected with its sedative action. Urinary retention's severity'potential for acute retention'sets it apart, requiring rapid reporting or catheterization. This aligns with amitriptyline's blockade of muscarinic receptors, where bladder dysfunction can escalate fast, making C the finding demanding urgent attention over chronic annoyances.

Correct Answer: D

Rationale: Emesis risk depends on chemotherapeutic emetogenicity. Cisplatin, dacarbazine, doxorubicin, and mustine are highly emetogenic, triggering vomiting via chemoreceptor zones. Vincristine, a vinca alkaloid, is least emetogenic, causing neuropathy instead, making it the exception. This lower risk reduces antiemetic needs, easing patient burden during treatment.

Correct Answer: B

Rationale: Cyanocobalamin, or vitamin B12, is essential for red blood cell production and neurological function, and its deficiency directly leads to pernicious anemia, a condition characterized by large, immature red blood cells due to impaired DNA synthesis. This occurs because B12 is crucial for folate metabolism and erythropoiesis, and without it, anemia develops, often accompanied by neurological symptoms like numbness or tingling. Pellagra, however, results from niacin (vitamin B3) deficiency, manifesting as dermatitis, diarrhea, and dementia-unrelated to B12's role. Rickets stems from vitamin D deficiency, causing bone deformities due to poor calcium absorption, not a B12 issue. Scurvy arises from vitamin C deficiency, leading to collagen breakdown and symptoms like bleeding gums, distinct from B12's hematological effects. Pernicious anemia stands out as the correct outcome because B12 deficiency disrupts bone marrow function, and it often requires pharmacotherapy, such as B12 injections, especially if absorption is impaired (e.g., due to lack of intrinsic factor). This specificity eliminates other conditions, highlighting B12's unique role in blood and nerve health.

Correct Answer: A

Rationale: Rivastigmine, an acetylcholinesterase inhibitor, treats Alzheimer's by increasing acetylcholine, improving cognition. Its transdermal patch delivers steady drug levels daily, minimizing peaks/troughs and reducing GI side effects (e.g., nausea) compared to oral forms, enhancing compliance. Donepezil, memantine, and galantamine are oral, lacking a once-daily patch; donepezil's long half-life mimics steady-state but isn't transdermal. Glatiramer treats MS, not Alzheimer's. Rivastigmine's patch formulation ensures consistent cholinergic enhancement, critical for sustained symptom relief in Alzheimer's, distinguishing it as the optimal choice here.

Correct Answer: D

Rationale: The best explanation for the prescription of the ACE inhibitor lisinopril for a patient with diabetes who does not have hypertension is that this medication has a protective effect on the kidneys for patients with diabetes. ACE inhibitors like lisinopril have been shown to have renal protective benefits by reducing the progression of diabetic nephropathy, a common complication of diabetes that affects the kidneys. Therefore, even in the absence of hypertension, using an ACE inhibitor like lisinopril can help preserve kidney function in patients with diabetes.