Correct Answer: B

Rationale: Avoiding alcohol is critical while taking methotrexate, as alcohol increases the risk of hepatotoxicity, a serious side effect of this immunosuppressive drug used for rheumatoid arthritis.
Choice A is incorrect because methotrexate can be taken with or without food, but a high-fat meal is not specifically recommended and may not affect absorption.
Choice C is incorrect because methotrexate takes weeks to months to relieve joint pain; it is not an immediate-acting analgesic.
Choice D is incorrect because methotrexate is typically taken once weekly (not daily at bedtime) to reduce systemic toxicity, and timing is flexible.

Correct Answer: D

Rationale: Dry mouth is a common adverse effect of duloxetine, an SNRI, due to its anticholinergic properties, and should be monitored to ensure client comfort and hydration.
Choice A is incorrect because duloxetine is more likely to cause weight gain or be weight-neutral, not weight loss.
Choice B is incorrect because hypotension is not a frequent side effect; orthostatic hypotension may occur but is less common.
Choice C is incorrect because tachycardia is not a primary side effect; it may occur with overdose or serotonin syndrome.

Correct Answer: C

Rationale: ST-segment elevation on ECG is a critical finding post-CABG, indicating possible myocardial ischemia or infarction, requiring immediate reporting to the provider for intervention.
Choice A is incorrect because incisional pain rated 4/10 is expected post-CABG and can be managed with analgesics; severe or worsening pain would be more concerning.
Choice B is incorrect because a temperature of 37.8°C is a low-grade fever, common in the first 48 hours post-surgery, and does not require immediate reporting unless persistent or higher.
Choice D is incorrect because drainage of 50 mL/hr from chest tubes is within the expected range for the first 24 hours post-CABG; excessive drainage (>100 mL/hr) would be concerning.

Correct Answer: A

Rationale: Crepitus (grating or crunching sound) with joint movement is a common finding in osteoarthritis due to cartilage degeneration and bone-on-bone contact.
Choice B is incorrect because osteoarthritis typically causes asymmetrical joint swelling, unlike rheumatoid arthritis, which is symmetrical.
Choice C is incorrect because morning stiffness in osteoarthritis is brief (less than 30 minutes), unlike rheumatoid arthritis, where it lasts longer (e.g., 2 hours).
Choice D is incorrect because fever is not a feature of osteoarthritis unless there is an infection or another condition.

Correct Answer: B

Rationale: Monitoring for signs of toxicity, such as tremor, nausea, or confusion, is critical with lithium, as it has a narrow therapeutic range, and toxicity can occur with dehydration or drug interactions.
Choice A is incorrect because a low-sodium diet can increase lithium levels, leading to toxicity; a consistent, normal-sodium diet is recommended.
Choice C is incorrect because lithium takes 1-2 weeks to stabilize mood, not 24 hours.
Choice D is incorrect because lithium can be taken with or without food; a high-fat meal is not necessary and may delay absorption.