The nurse is giving instructions to a client receiving phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that:

Correct Answer: D

Rationale: Monitoring serum phenytoin levels is essential to ensure therapeutic efficacy and avoid toxicity. Wearing a medical alert tag is recommended for clients on phenytoin. Alcohol should be avoided, and taking the medication with milk can interfere with absorption. Therefore, the correct statement indicating sufficient knowledge is about monitoring serum levels.

Correct Answer: A

Rationale: Digoxin is commonly used to treat atrial flutter and atrial fibrillation by helping to control the heart rate. A loading dose may be given initially to reach therapeutic levels quickly. This medication acts by increasing the force of the heart's contractions and slowing down the heart rate. Propranolol (Choice B) is a beta-blocker used to treat various heart conditions, but it is not typically used for atrial arrhythmias like atrial flutter. Ibuprofen (Choice C) is a nonsteroidal anti-inflammatory drug used for pain and inflammation, not for cardiac arrhythmias. Lithium (Choice D) is a mood-stabilizing medication often used for bipolar disorder and is not indicated for atrial flutter treatment.

Correct Answer: C

Rationale: Codeine, an opioid antitussive, can cause respiratory depression as a side effect. The nurse must assess the patient’s respiratory rate before administration to ensure it is within a safe range (typically >12 breaths per minute). While lung sounds (B) and sputum consistency (D) are important, they are not the priority when administering a medication that can suppress respiration. Pulse oximetry (A) is useful but secondary to direct respiratory rate assessment.

Correct Answer: B

Rationale: The first pass effect refers to the metabolism of a drug occurring as it passes from the gastrointestinal tract (GUT lumen) to the liver, before reaching the systemic circulation. This process can significantly reduce the amount of active drug that enters systemic circulation, impacting the drug's overall effectiveness. The first pass effect is an important consideration in pharmacokinetics as it affects the bioavailability of a drug and influences dosing regimens. Options A, C, D, and E do not specifically pertain to the metabolism of a drug en route from the GUT lumen to the systemic circulation as described in the question.

Correct Answer: D

Rationale: Schizophrenia's negative symptoms include apathy and withdrawal, seen in quietness and disinterest . Depression needs more evidence. Voices suggest positive symptoms, absent here. Positive symptoms add behaviors, not subtract. D aligns with schizophrenia's clinical presentation, making it the correct interpretation.