The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time?

Correct Answer: B

Rationale: Paroxetine's effectiveness waning after a year suggests possible drug interactions reducing its levels or efficacy, a common issue needing assessment via medication review. Needing a change assumes a conclusion without evidence. Paxil and paroxetine are the same (brand vs. generic), making that question moot. Beck assessment evaluates depression, not drug failure. Interactions align with pharmacokinetic principles, offering a proactive step to identify culprits like enzyme inducers, critical for adjusting therapy.

Correct Answer: A

Rationale: The best response by the nurse is option A: "It is working, but it can take several weeks to have an effect." This response is correct because amitriptyline, a tricyclic antidepressant, often takes time to build up in the patient's system and reach therapeutic levels. It is important for the nurse to educate the patient about the delayed onset of action of this medication to manage the patient's expectations and encourage adherence to the treatment plan. Option B is incorrect because it minimizes the patient's feelings of depression and does not address the pharmacological mechanism of action of the medication. Option C is incorrect because discontinuing the medication without consulting the healthcare provider can be dangerous and may exacerbate the patient's symptoms. Option D is incorrect because while it is true that tricyclic antidepressants may take several weeks to show full therapeutic effects, it is not accurate to state that it can take several months. From an educational perspective, this question highlights the importance of patient education and managing expectations when administering psychotropic medications. It underscores the need for healthcare providers to communicate effectively with patients about the anticipated timeline for therapeutic effects of medications to ensure optimal outcomes and adherence to treatment plans.

Correct Answer: C

Rationale: Rheumatoid arthritis (RA) progression despite methotrexate warrants a TNF-α inhibitor. The description-recombinant human IgG fused to TNF-α receptor-points to Etanercept . Adalimumab and Golimumab are monoclonal antibodies against TNF-α, not receptor fusions. Certolizumab is a PEGylated Fab fragment, not IgG-based. Etanercept , a fusion protein, binds TNF-α, neutralizing it, and matches the question's structure. Infliximab (E) is a chimeric antibody. Etanercept's unique receptor-IgG design distinguishes it, effectively reducing RA inflammation by sequestering TNF-α, a key cytokine, making it the precise answer here.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Megaloblastic anemia. Trimethoprim, as a folate antagonist, can inhibit folic acid metabolism in the body. This interference can lead to megaloblastic anemia, characterized by the production of large, immature red blood cells. This type of anemia is a well-known side effect of long-term trimethoprim therapy. A) Aplastic anemia is an incorrect option because trimethoprim does not typically cause suppression of the bone marrow, which is characteristic of aplastic anemia. C) Microcytic anemia is not the likely hematologic effect of long-term trimethoprim use. This type of anemia is usually associated with iron deficiency and not with the mechanism of action of trimethoprim. D) Normocytic anemia is also an incorrect option. Trimethoprim's effect on folic acid metabolism typically leads to megaloblastic anemia rather than normocytic anemia. Educationally, understanding the hematologic side effects of medications is crucial for healthcare professionals in providing safe and effective patient care. Pharmacology knowledge helps in predicting and managing potential adverse effects, ensuring optimal medication therapy for patients. Being able to recognize and differentiate between different types of anemia based on their etiology is a key skill for healthcare providers when assessing and managing patients with hematologic conditions.

Correct Answer: A

Rationale: The correct answer is A) Eyes remain open. Phencyclidine (PCP) is a dissociative drug that can cause hallucinations, distorted perceptions of sounds, and violent behavior. Taking a 'triple dose' of PCP can lead to the individual experiencing a state of agitation, hallucinations, and a dissociative state where they appear to be awake but are disconnected from reality. This can result in their eyes remaining open while exhibiting bizarre and unpredictable behavior. Option B) Loss of consciousness is incorrect because PCP typically does not cause individuals to lose consciousness, but rather can induce a state of hyperactivity and agitation. Option C) Numbness of extremities is incorrect because PCP does not typically cause numbness but rather alters sensation and perception. Option D) Rapid, normal gait is incorrect because PCP can cause individuals to have impaired coordination, unsteady gait, and even experience a sense of floating or detachment from their body, making a normal gait unlikely. In an educational context, understanding the effects of substances like PCP is crucial for healthcare professionals to provide appropriate care and interventions for individuals who may be under the influence. Recognizing the signs and symptoms of PCP intoxication can help in managing the individual's behavior and ensuring their safety. It also highlights the importance of substance abuse education and prevention in addressing the risks associated with drug misuse.