Tricyclic antidepressants

Correct Answer: B

Rationale: Tricyclic antidepressants (TCAs) like imipramine block norepinephrine and serotonin reuptake, but their anticholinergic effects are significant. In glaucoma, particularly angle-closure type, these effects can increase intraocular pressure by dilating pupils and obstructing aqueous humor outflow, risking acute attacks—thus, they're contraindicated. TCAs lower seizure threshold, lacking anticonvulsant activity, and may exacerbate epilepsy. They don't enhance levodopa absorption; rather, they might interact via monoamine pathways, but this isn't a primary effect. Some TCAs (e.g., amitriptyline) have quinidine-like sodium channel blockade, giving antiarrhythmic properties, but this isn't their primary use. The glaucoma concern is critical due to the anticholinergic mechanism, making it a key clinical consideration and the most accurate statement here.

Correct Answer: A

Rationale: Finasteride, a 5-alpha reductase inhibitor, is used as Proscar for benign prostatic hyperplasia (BPH) and as Propecia for male pattern baldness, reducing dihydrotestosterone to promote hair growth. Without prostate issues, baldness is a likely reason for its use. Erectile dysfunction isn't treated by finasteride-it may cause it-making that irrelevant. Stomach ulcers and hypertension aren't linked to finasteride's androgen-targeted action. Asking about baldness probes a condition tied to its alternative use, clarifying the prescription's purpose and guiding the nurse's understanding of the client's therapy.

Correct Answer: C

Rationale: Chronic heart failure (CHF) decompensation needs optimization. Morphine relieves acute dyspnea but not chronic management here. Hydralazine/isosorbide reduces afterload/preload, useful in advanced CHF, but less immediate. Carvedilol, a beta-blocker, risks decompensation with low BP. Metolazone, a potent diuretic, aids fluid overload but overlaps with furosemide. Digoxin improves contractility and rate control in sinus rhythm CHF, reducing hospitalizations, most appropriate given his recurrent admissions and stable renal function. Its inotropic benefit stabilizes this patient, enhancing quality of life.

Correct Answer: A

Rationale: The regulation of arterial blood pressure is primarily determined by two main parameters: cardiac output and systemic vascular resistance.

Correct Answer: A

Rationale: Ondansetron is an example of a serotonin antagonist antiemetic that is effective in preventing and treating nausea and vomiting related to chemotherapy. It works by blocking serotonin receptors both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone. By antagonizing serotonin, ondansetron helps to reduce the emetic response triggered by chemotherapy, leading to improved control of nausea and vomiting. In contrast, the other options (B. fluoxetine, C., D. paroxetine, E. sertraline) are selective serotonin reuptake inhibitors (SSRIs) used mainly for the treatment of depression and anxiety disorders, and they do not have the same antiemetic properties as ondansetron.

Correct Answer: C

Rationale: Nystatin is an antifungal medication used to treat fungal infections, such as candidiasis. Before administration, assessing whether the client could be pregnant is critical because nystatin's safety in pregnancy is not fully established (Category C), meaning potential risks to the fetus cannot be ruled out without further evaluation. This makes pregnancy status a key safety consideration to prevent harm to an unborn child, outweighing other factors in urgency. The type of diet or amount of fat might influence general health or drug absorption minimally but isn't directly critical to nystatin's administration. Height and weight could affect dosing in some medications, but nystatin's dosing is typically standard and not weight-based for most fungal infections. Thus, confirming pregnancy status ensures the drug's safety profile aligns with the client's condition, making choice C the most critical assessment data to review prior to administration.

Correct Answer: C

Rationale: Myelosuppression, the suppression of bone marrow activity, is the most common dose-limiting toxicity of chemotherapy. It leads to reduced production of blood cells, including white blood cells, red blood cells, and platelets, increasing the risk of infections, anemia, and bleeding. While nausea, vomiting, and mucositis are significant side effects, they can often be managed with supportive care. Myelosuppression, however, can be life-threatening and frequently requires dose adjustments or delays in treatment. Bloody stools are less common and typically not the primary dose-limiting factor.

Correct Answer: B

Rationale: Mitoxantrone for MS progression risks hepatitis . This chemotherapeutic damages liver cells, requiring monitoring. Anxiety , hypopyrexia , muscle strength , and leukocytosis (E) aren't primary. Hepatotoxicity, with cardiotoxicity, is a key concern in this worsening MS case.

Correct Answer: D

Rationale: Metoprolol would be the best choice because it has an extended-release form that only needs to be taken once a day, which should increase patient compliance. Acebutolol, atenolol, and bisoprolol do not come in extended-release forms. The nurse should consider the patient’s lifestyle and preferences when selecting antihypertensive medications to improve adherence.