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: 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: D

Rationale: Nitroglycerin is a medication commonly used in the treatment of angina pectoris (chest pain) and heart failure. Its primary action is to dilate the coronary arteries, which are the blood vessels that supply the heart muscle with oxygen and nutrients. By dilating these arteries, nitroglycerin helps to increase blood flow to the heart and reduce the workload on the heart muscle, thereby relieving chest pain and improving overall heart function. This vasodilatory effect of nitroglycerin also helps in reducing blood pressure and increasing oxygen supply to the heart. Therefore, the correct action of nitroglycerin is to dilate the coronary arteries.

Correct Answer: A

Rationale: Docusate is a stool softener used to prevent constipation. If the patient is already experiencing loose stools, administering docusate could exacerbate the condition, leading to diarrhea or dehydration. The nurse should hold the medication and inform the healthcare provider to reassess the need for docusate. Increasing the IV flow rate (C) or the dose (D) is inappropriate in this situation.

Correct Answer: D

Rationale: To help reduce tolerance to transdermal nitroglycerin therapy, it is often recommended to remove the patch at bedtime and then apply a new one in the morning. This drug-free period during sleep helps prevent the development of tolerance to nitroglycerin. By allowing the body to have a break from continuous exposure to the drug, the effectiveness of nitroglycerin can be maintained over time.