You have been monitoring a 62-year-old man who is a retired small business owner over the past year and have noted a slowly changing intraocular pressure bilaterally. You have started him on physostigmine to treat his open-angle glaucoma. How does physostigmine affect intraocular pressure?

Correct Answer: C

Rationale: Physostigmine, a cholinesterase inhibitor, lowers IOP in glaucoma by increasing aqueous outflow . It contracts the ciliary muscle, opening the trabecular meshwork. Secretion or synthesis reduction isn't its mechanism. Raising pressure (D, E) contradicts its use. This aids drainage in open-angle glaucoma.

Correct Answer: C

Rationale: Lisinopril, an ACE inhibitor, manages hypertension but requires adherence even if symptoms improve, as stopping abruptly risks rebound hypertension, indicating a teaching gap. Reporting a dry cough is correct due to bradykinin buildup, a common side effect needing evaluation. Rising slowly prevents orthostatic hypotension, a known effect. Avoiding potassium-rich salt substitutes prevents hyperkalemia, as lisinopril inhibits aldosterone. The statement ‘I can stop this medication if I feel better' reflects misunderstanding of chronic disease management, where consistent therapy maintains control, not just symptom relief. Further teaching must emphasize this, aligning with lisinopril's role in long-term vascular protection, making C the statement needing correction.

Correct Answer: B

Rationale: Enteral formulas are categorized as elemental/semi-elemental (B), disease-specific (C), polymeric formula (D), and modular formula (E). Enteral macronutrient (A) is not a recognized category. These formulas are tailored to meet specific nutritional needs based on the patient's condition.

Correct Answer: A

Rationale: Diphenhydramine's anticholinergic effects (dryness) are tolerable given 75% rhinitis improvement. Continue at current dose . Discontinuing loses benefit. Adding chlorpheniramine increases side effects. Surgery (D, E) is excessive. Balancing efficacy and mild side effects favors continuation.

Correct Answer: C

Rationale: Hydrochlorothiazide is a diuretic medication commonly used to treat hypertension (high blood pressure) and edema (fluid retention). It works by increasing the amount of water and salt that the kidneys remove from the blood, leading to decreased blood volume and lower blood pressure. Diuretics like hydrochlorothiazide are not used to treat inflammation, arrhythmias, or fungal infections, making option C the correct classification for this medication.

Correct Answer: A

Rationale: Interferon Alfa-2b, used for hepatitis or cancer, commonly causes flu-like symptoms—dizziness , fatigue , and anorexia —due to its immune-modulating effects. Dizziness reflects CNS impact, often early in therapy, while fatigue and appetite loss stem from systemic inflammation. An itchy rash might suggest hypersensitivity but is less frequent than these systemic effects. The nurse identifies dizziness as a common adverse effect (correct answers: 1, 3, 4), distinguishing it from severe reactions requiring intervention. This aligns with interferon's side effect profile, where patients often report such symptoms within days of starting, necessitating education on management (e.g., rest, hydration). Choice A is a key identifier among expected effects, ensuring appropriate monitoring.

Correct Answer: A

Rationale: The correct statement by the nurse is to instruct the patient to "stop taking the diuretic for a few days, and then restart it when you feel better." This is because the patient has been experiencing vomiting due to influenza, which can cause dehydration. Continuing the diuretic while experiencing such significant fluid loss can lead to further dehydration and electrolyte imbalances. It is important for the patient to pause the diuretic temporarily to allow the body to recover and then resume once the vomiting has subsided and hydration has improved. It's always best for patients to follow specific instructions given by healthcare providers in such situations.

Correct Answer: A

Rationale: Furosemide is a loop diuretic commonly used to treat conditions involving edema such as heart failure, liver disease, and kidney disorders. By promoting diuresis (increased urine production), furosemide helps the body eliminate excess fluid, leading to a decrease in edema or swelling. Therefore, a patient given furosemide for diuresis should experience a decrease in edema as the drug acts on the kidneys to increase urine output and eliminate extra fluids from the body.

Correct Answer: B

Rationale: Individual variation-metabolism, weight, genetics-dictates dose differences, a pharmacokinetic truth explaining her higher amount. Female metabolism isn't universally higher. Hormones affect response, but not broadly dose. Body fat impacts distribution, not directly dose here. Uniqueness covers all factors, reassuring and accurate.