The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the priority assessment by the nurse include?

Correct Answer: A

Rationale: Imipramine, a tricyclic antidepressant, is highly cardiotoxic in overdose, often causing fatal dysrhythmias due to sodium channel blockade, leading to widened QRS complexes and ventricular arrhythmias. The priority assessment must focus on cardiac status to detect life-threatening changes like tachycardia or arrhythmias, requiring immediate intervention such as sodium bicarbonate or cardioversion. Liver function and renal status may be affected long-term but aren't the acute priority in overdose. Neurological function , while impacted (e.g., seizures), is secondary to cardiac risks, as circulatory collapse poses the greatest immediate threat. The nurse's focus on cardiac monitoring aligns with toxicology protocols, ensuring rapid response to the most lethal complication, making choice A the critical assessment in this emergency scenario.

Correct Answer: C

Rationale: Cyclosporine, a common immunosuppressive medication used in post-renal transplantation clients, can cause a range of adverse effects, including hypertension, nephrotoxicity, and electrolyte imbalances. One of the significant side effects of cyclosporine is causing an elevation in the pulse rate, also known as tachycardia. Tachycardia is a common side effect of cyclosporine due to its direct effects on the cardiovascular system. Therefore, in the context of a post-renal transplantation client taking cyclosporine, an elevation in pulse rate is the most likely vital sign to be increased. Sweatiness may be a response to the increased heart rate and may also be a side effect of cyclosporine. However, the primary vital sign affected by cyclosporine would be the pulse rate.

Correct Answer: C

Rationale: Glaucoma involves elevated intraocular pressure (IOP), and this patient's exacerbation-vision difficulty and headaches-requires effective IOP reduction. Bimatoprost and Latanoprost are prostaglandin analogs, increasing outflow, but may not act fast enough for acute worsening. Pilocarpine , a muscarinic agonist, contracts the ciliary muscle, opening the trabecular meshwork, enhancing aqueous humor outflow, and rapidly lowering IOP-ideal for this scenario. Tetracycline is an antibiotic, irrelevant. Travoprost (E), another prostaglandin, is similar to A and B. Pilocarpine's direct action on outflow makes it most appropriate for urgent IOP control in open-angle or angle-closure glaucoma exacerbation. Its side effects (miosis, brow ache) are tolerable given the need for immediate relief, distinguishing it from slower-acting prostaglandins.

Correct Answer: C

Rationale: The rights of medication administration include the right patient, right medication, right dose, right route, right time, and right documentation. However, "right attitude" is not one of the recognized rights of medication administration. While having a positive and professional attitude is important for healthcare providers, it is not specifically listed as a distinct right in medication administration protocols.

Correct Answer: D

Rationale: Warfarin is an anticoagulant medication that works by inhibiting vitamin K-dependent clotting factors in the body. Overdosing on warfarin can lead to excessive bleeding due to the lack of functional clotting factors. To reverse the effects of warfarin overdose, Vitamin K is given because it helps the body restore the levels of clotting factors that were reduced by warfarin. Vitamin K promotes the synthesis of clotting factors II, VII, IX, and X, which allows the blood to clot effectively again. Therefore, in the case of a warfarin overdose, Vitamin K is the appropriate antidote to help reverse the anticoagulant effects.

Correct Answer: D

Rationale: Pain is a significant contributor to the debilitation of an individual during a course of chemotherapy. The side effects of chemotherapy often include pain, which can be caused by treatment procedures, side effects of medication, or the cancer itself. Pain can lead to decreased mobility, appetite, and overall quality of life, impacting the individual's ability to cope with treatment and recovery. Managing pain effectively is crucial in improving the patient's comfort and overall well-being during chemotherapy. While diarrhea, alopecia, and constipation are common side effects of chemotherapy, they do not typically contribute as significantly to the debilitation of an individual compared to pain.

Correct Answer: D

Rationale: Methyldopa is the preferred antihypertensive medication for pregnant women experiencing hypertension. It has been extensively studied and considered safe for both the mother and the fetus. Methyldopa has been shown to effectively lower blood pressure in pregnant women without causing harm to the developing fetus. Other antihypertensive medications, such as Enalapril (Vasote) and Hydrochlorothiazide (HydroDIURIL), are contraindicated during pregnancy as they can cause harm to the fetus. Mannitol (Osmitrol) is an osmotic diuretic primarily used for reducing intracranial pressure or treating cerebral edema, not for hypertension in pregnancy. Therefore, Methyldopa is the right choice for a pregnant patient with hypertension.

Correct Answer: A

Rationale: Nystatin treats oral thrush by direct mucosal contact, requiring the tablet to dissolve in the mouth for prolonged exposure before swallowing. This maximizes antifungal action against Candida. Using a straw might apply to suspensions but isn't standard for discoloration prevention, which isn't a primary issue. Crushing and mixing with juice reduces contact time, decreasing efficacy. Swallowing whole bypasses the infection site, rendering it ineffective. The nurse's best plan educates on dissolving the tablet, aligning with nystatin's topical mechanism, ensuring treatment success and preventing recurrence, making A the optimal instruction.

Correct Answer: A

Rationale: Carvedilol is available orally and is used to treat hypertension as well as congestive heart failure and left ventricular dysfunction after a myocardial infarction. Sotalol is a nonselective beta-adrenergic blocking agent used to treat potentially life-threatening ventricular arrhythmias and to maintain normal sinus rhythm in patients with atrial fibrillation or flutter. Propranolol is a nonselective beta-adrenergic blocking agent used for treatment of hypertension, angina, idiopathic hypertrophic subaortic stenosis (IHSS) induced palpitations, angina and syncope, some cardiac arrhythmias induced by catecholamines or digoxin, pheochromocytoma; prevention of reinfarction after myocardial infarction; prophylaxis for migraine headache (which may be caused by vasodilation and is relieved by vasoconstriction, although the exact action is not clearly understood); prevention of stage fright (which is a sympathetic stress reaction to a particular situation); and treatment of essential tremors. Tamsulosin is used to treat benign prostatic hyperplasia and is an alpha1-selective adrenergic blocking agent.