The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesn't think this medicine is working, as he is still depressed. What is the best response by the nurse?

Correct Answer: A

Rationale: Amitriptyline, a tricyclic antidepressant, typically requires 2 to 6 weeks to achieve full therapeutic effect, as it gradually increases neurotransmitter levels (e.g., serotonin, norepinephrine) in the brain to alleviate depression. After only 2 weeks, the patient's continued symptoms are expected, not indicative of failure, making choice A the best response: it educates the patient on the timeline, fostering adherence. Choice B dismisses the patient's feelings with subjective reassurance, undermining trust. Choice C prematurely suggests switching drugs without evidence, risking unnecessary changes. Choice D exaggerates the timeline to months, which is inaccurate and discouraging. The nurse's role is to provide accurate information and support, reinforcing that delayed onset is normal for this class of medication, thus making choice A the most therapeutic and evidence-based response.

Correct Answer: B

Rationale: Sympathomimetic amines are compounds that mimic the effects of the sympathetic nervous system. Options A, C, D, and E (epinephrine, norepinephrine, levonordefrin, and phenylephrine) are all sympathomimetic amines commonly used in dentistry for their vasoconstrictive properties. Felypressin, on the other hand, is a synthetic vasopressin analog and does not have sympathomimetic properties. It is commonly used in dentistry as a local vasoconstrictor to prolong the anesthetic effect.

Correct Answer: A

Rationale: Monitor vital signs and assess cardiovascular status including pulse, blood pressure, and cardiac output to evaluate for possible cardiac effects. Although assessment of bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels may be important to patient care, they are not related to administration of a nonselective adrenergic blocking agent. The nurse should prioritize cardiovascular assessments to ensure patient safety.

Correct Answer: D

Rationale: Given the patient's history of liver transplant and current medications (prednisone and azathioprine), the nurse should pay close attention to an increased cholesterol level. Corticosteroids (such as prednisone) and immunosuppressants (such as azathioprine) can both contribute to dyslipidemia, leading to elevated cholesterol levels. Monitoring cholesterol levels is crucial in this patient population to assess cardiovascular risk and potentially adjust medications or lifestyle interventions accordingly. The other findings mentioned (soft non-tender lump in the shoulder, grade 1+ pitting edema in the feet, swollen and pinkish gums) may be important to note but do not directly relate to the patient's history of liver transplant and medication regimen.

Correct Answer: B

Rationale: Buspirone, a 5HT1A partial agonist, treats GAD by modulating serotonin without sedative or euphoric effects, making it ideal for patients with substance abuse histories like secobarbital (a barbiturate). It lacks abuse potential, unlike benzodiazepines, and doesn't cause dependence, aligning with the patient's needs. Bupropion, an NE/DA reuptake inhibitor, targets depression and smoking cessation, not GAD, and has stimulant-like risks. Baclofen, a GABA_B agonist, manages spasticity, not anxiety, and has some abuse potential. Buprenorphine, an opioid partial agonist, treats addiction but not GAD and carries dependence risk. Phenobarbital, a barbiturate, mirrors the patient's abuse history and is contraindicated. Buspirone's efficacy in GAD, non-addictive nature, and safety in this context make it the optimal choice.