What would be appropriate for a 15-year-old girl diagnosed with ADHD who occasionally smokes marijuana with friends?

Correct Answer: C

Rationale: Dextroamphetamine would be the most appropriate choice for this patient as it is a stimulant commonly used to treat ADHD. It can help improve focus, attention, and impulse control in individuals with ADHD. Since the girl admitted to occasional marijuana use, medications like methylphenidate (A) or clonidine (B) may not be as effective due to potential interactions or lack of effectiveness. Alprazolam (D) is a benzodiazepine used for anxiety, not ADHD. Atomoxetine (E) is another medication for ADHD, but dextroamphetamine is often preferred based on patient response and history.

Correct Answer: B

Rationale: Buprenorphine, as a partial agonist at µ (mu) receptors and a full agonist at κ (kappa) receptors, is a suitable choice for managing pain in a patient with osteoarthritis. Its dual mechanism of action can provide effective pain relief while reducing the risk of tolerance and dependence associated with full opioid agonists. Therefore, in the case of worsening joint pain in an osteoarthritis patient, buprenorphine would be a likely choice to alleviate the pain effectively.

Correct Answer: B

Rationale: Constriction of the renal vascular bed is a common effect of opioids like morphine, which can help reduce fluid overload and improve cardiac function in patients with impending pulmonary edema. This constriction leads to a decrease in renal blood flow and subsequently decreases the filtration of fluid into the kidneys, alleviating symptoms of pulmonary edema. This effect helps to reduce the patient's overall fluid volume and cardiac workload, contributing to the therapeutic benefit in the context of heart failure.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Impairment of far vision. After receiving a standard dose of morphine, a common adverse effect is impaired vision, particularly far vision. Morphine is a central nervous system depressant that can cause miosis (constriction of the pupils) leading to difficulty in focusing on distant objects. Option A) Dysphoria is not a common adverse effect of morphine but rather a potential side effect of some other medications like ketamine or certain antidepressants. Option C) Diarrhea is not a typical adverse effect of morphine. In fact, opioids like morphine more commonly cause constipation due to their effects on the gastrointestinal system. Option D) Hypertension is not a typical adverse effect of morphine. Morphine more commonly causes hypotension (low blood pressure) due to its vasodilatory effects. Educationally, understanding the common adverse effects of central nervous system stimulants like morphine is crucial for nurses and healthcare professionals to provide safe and effective care to patients. Knowing how to recognize and manage these adverse effects is essential in promoting patient safety and positive health outcomes.

Correct Answer: D

Rationale: The correct answer is D) Acetaminophen speeds up the biotransformation of codeine into morphine. This combination is used for pain control because acetaminophen enhances the conversion of codeine, a prodrug, into its active form, morphine, which provides analgesic effects. Acetaminophen itself has limited analgesic properties but when used in combination with codeine, it helps to boost the pain-relieving effects of the medication. Option A is incorrect because codeine itself does not counteract acetaminophen-induced hepatotoxicity; in fact, the combination may increase the risk of liver damage if not used cautiously. Option B is incorrect as acetaminophen does not counteract codeine-induced constipation; constipation is a common side effect of opioids like codeine. Option C is incorrect as the combination of acetaminophen and codeine can still lead to tolerance and dependence, especially with prolonged use. In an educational context, understanding the rationale behind combining acetaminophen and codeine for pain control is crucial for healthcare providers to make informed decisions about pain management strategies for patients. It also highlights the importance of pharmacokinetics and drug interactions in optimizing therapeutic outcomes while minimizing adverse effects in clinical practice.