Which antiparkinsonian drug is associated with the on-off phenomenon and the wearing-off effect?

Correct Answer: B

Rationale: Levodopa is the antiparkinsonian drug associated with the on-off phenomenon and the wearing-off effect. The on-off phenomenon refers to the sudden and unpredictable fluctuations between periods of symptom control (on) and periods of symptom re-emergence (off) in patients with Parkinson's disease receiving levodopa therapy. This can happen as the disease progresses and the brain becomes less responsive to the medication.

Correct Answer: D

Rationale: In the syndrome of inappropriate antidiuretic hormone (SIADH), there is an excessive release of antidiuretic hormone (ADH), leading to water retention by the kidneys and dilution of electrolytes in the blood. This can result in hyponatremia and fluid overload. Therefore, the appropriate nursing intervention for a client with SIADH is to restrict fluids to help prevent further fluid retention and worsening of hyponatremia. Infusing IV fluids rapidly, administering glucose-containing IV fluids, or encouraging increased oral fluid intake would exacerbate the problem by further diluting the electrolyte concentration in the blood. By restricting fluids, the aim is to maintain a strict intake and output balance to promote a gradual increase in serum sodium levels and help restore normal fluid balance in the body.

Correct Answer: A

Rationale: Following a unilateral adrenalectomy, there is a risk of developing hyperkalemia due to the altered balance of electrolytes. Hyperkalemia is characterized by high levels of potassium in the blood, which can lead to various symptoms. One of the key manifestations of hyperkalemia is muscle weakness. This occurs because high potassium levels can disrupt the normal function of skeletal muscles, leading to weakness and potentially affecting motor function. Therefore, the nurse would assess for muscle weakness as a sign of hyperkalemia in a patient following a unilateral adrenalectomy. Options B, C, and D are not typically associated with hyperkalemia.

Correct Answer: B

Rationale: After a right lower lobectomy, it is important to keep the patient in a semi-Fowler's position to promote lung expansion and oxygenation. This position helps to reduce pressure on the diaphragm and allows for better lung ventilation. By maintaining the patient in a semi-Fowler's position, it can help prevent complications such as atelectasis and pneumonia postoperatively. It is a crucial nursing intervention to ensure optimal respiratory function and promote recovery after lung surgery.

Correct Answer: B

Rationale: In the scenario of an elderly patient like Mr. Cruz with suspected pulmonary embolism, the nurse would anticipate an order for the immediate administration of heparin. Heparin is an anticoagulant medication that works quickly to prevent the further development of blood clots. It is often used as the initial treatment for pulmonary embolism to prevent existing blood clots from getting larger and reduce the risk of new clots forming. Heparin is preferred over warfarin initially because it has a more rapid onset of action. Warfarin, which is a commonly used anticoagulant for longer-term management, takes several days to reach its full effect and requires monitoring of the prothrombin time (INR). Therefore, in Mr. Cruz's acute situation, heparin would be the most appropriate choice for immediate intervention to address the pulmonary embolism.