The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment?

Correct Answer: D

Rationale: Escitalopram and St. John's wort, both serotonin boosters, risk serotonin syndrome-hyperthermia, diaphoresis-per pharmacology. St. John's toxicity alone (e.g., photosensitivity) doesn't fit. They're not safe together-interaction is known. Withdrawal lacks agitation context. Serotonin excess explains symptoms, a critical finding.

Correct Answer: B

Rationale: Allopurinol is primarily used to prevent gout and hyperuricemia, which are common side effects of chemotherapy. Chemotherapy often leads to the rapid destruction of cancer cells, releasing large amounts of uric acid into the bloodstream. This can cause hyperuricemia, leading to gout or kidney stones. Allopurinol works by inhibiting xanthine oxidase, an enzyme involved in uric acid production, thereby reducing uric acid levels. While myelosuppression and pancytopenia are concerns during chemotherapy, they are not directly addressed by allopurinol. Similarly, allopurinol does not inhibit cancer cell growth or replication.

Correct Answer: B

Rationale: One important side effect to watch for when administering the drug lithium is seizures. Lithium is commonly used to treat bipolar disorder, but it can lower the seizure threshold and increase the risk of seizures in some patients. It is crucial to monitor individuals taking lithium for any signs of seizures or seizure activity and to promptly address any such occurrences. Regular monitoring of lithium levels and adjusting the dosage as necessary can help minimize the risk of seizures in patients receiving this medication.

Correct Answer: B

Rationale: Pentazocine, a mixed opioid agonist-antagonist, acts as a kappa receptor agonist and a partial mu receptor agonist, providing analgesia in opioid-naive patients. However, in a heroin addict with high mu receptor tolerance, pentazocine's partial antagonism at mu receptors can displace full agonists like heroin, precipitating withdrawal symptoms—sweating, restlessness, and heightened pain perception. Tolerance to pentazocine itself wouldn't typically increase pain; it would reduce efficacy. Pentazocine is an effective analgesic in appropriate contexts, so ineffectiveness isn't the issue. Incorrect dosing might alter efficacy or toxicity but wouldn't specifically cause this withdrawal-like reaction. The patient's history of heroin use explains this response, as pentazocine's antagonist properties disrupt the opioid equilibrium, unmasking withdrawal in a dependent individual.

Correct Answer: A

Rationale: All four options would be appropriate nursing diagnoses for a patient receiving an adrenergic blocking agent. However, acute pain would be the only nursing diagnosis related to the patient’s comfort level. The nurse should address pain management as a priority to improve the patient’s quality of life and adherence to treatment.

Correct Answer: D

Rationale: St. John's wort is an herbal supplement known to interact with many medications, including venlafaxine (Effexor). It can reduce the effectiveness of venlafaxine by increasing its metabolism and clearance from the body, potentially leading to decreased therapeutic effects. Therefore, patients taking venlafaxine for social anxiety disorder should be advised to avoid St. John's wort to prevent any negative interactions and ensure the medication works effectively. It is essential for the nurse to inquire about the use of St. John's wort during the medication and dietary history assessment to prevent such interactions.

Correct Answer: C

Rationale: When administering IV potassium to a hypokalemic patient who is not on a heart monitor, it's important to ensure a controlled rate of infusion to prevent dangerous cardiac arrhythmias. The recommended maximum rate for IV potassium replacement in this scenario is typically no more than 20 mEq/hour. Faster administration rates can increase the risk of hyperkalemia and potentially lead to serious cardiac complications. Monitoring the patient closely for signs of hyperkalemia such as ECG changes or muscle weakness is also crucial during potassium replacement therapy.

Correct Answer: D

Rationale: Furosemide (Lasix) is a loop diuretic that helps the body to remove excess salt and water, which can be useful in conditions like congestive heart failure, liver disease, or kidney disorders. The correct statement by the nurse is to "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes." This instruction is important because diuretics like furosemide can cause changes in blood pressure, leading to dizziness and fainting when standing up quickly. By changing positions slowly, the patient can minimize the risk of experiencing these symptoms.

Correct Answer: B

Rationale: Grapefruit juice can interact with antilipemic medications, specifically statins, causing increased drug levels in the bloodstream. This can lead to a higher risk of side effects and adverse reactions. Therefore, patients on antilipemic therapy should be cautious about consuming grapefruit juice to prevent potential drug interactions.