Nokea
A 59-year-old man with a history of depression cuts his wrists in a suicide attempt. He is brought to the local emergency department for care. He has bilateral medial 3-cm lacerations through the skin and subcutaneous tissues that will require sutures. A review of his prior medical history indicates an allergy to 2% lidocaine. The most likely explanation for this is which of the following?
- A. Allergic
- B. Mast cell mediated
- C. Neurogenic
- D. Psychogenic
Correct Answer: A
Rationale: Lidocaine allergy causing an issue with suturing suggests an allergic reaction , likely IgE-mediated (overlapping with B, but A is broader). Neurogenic , psychogenic , and vascular (E) don't fit. True local anesthetic allergies are rare but explain this history.
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A local municipality is alerted that low doses of carbon tetrachloride have been dumped into the drinking water. A public health alert is transmitted to all residents of this town. Which of the following signs and symptoms should these residents be aware of?
- A. Convulsions
- B. Eye irritation
- C. Nausea
- D. Stupor
Correct Answer: C
Rationale: Carbon tetrachloride exposure causes nausea , reflecting GI and hepatic toxicity. Convulsions and stupor occur with high doses. Eye irritation and vomiting (E) are less specific. Low-dose ingestion aligns with nausea as a primary symptom.
Enteric coated acetylsalicylic acid has been prescribed for a patient to treat chronic arthritis. The patient calls the clinic nurse because of gagging and difficulty swallowing the tablets. What response would the nurse give to the patient?
- A. Crush the tablets and mix with juice or food'
- B. I’ll notify the healthcare provider for a medication change'
- C. Open the tablet and mix the contents with food'
- D. Swallow the tablets with large amounts of water or milk'
Correct Answer: D
Rationale: Enteric-coated tablets should not be crushed or opened, as this disrupts their protective coating and can cause gastric irritation. The patient should be instructed to swallow the tablets whole with plenty of water or milk. Crushing (A) or opening the tablets (C) is inappropriate. Notifying the healthcare provider (B) may be necessary if the patient cannot tolerate the medication.
The nurse administers IV push hydralazine (Apresoline) to a client with severe hypertension. Which assessment finding requires immediate action?
- A. Blood pressure of 140/90 mmHg
- B. Heart rate of 110 beats per minute
- C. Headache
- D. Flushing
Correct Answer: B
Rationale: Hydralazine, a vasodilator, lowers blood pressure but triggers reflex tachycardia. A heart rate of 110 bpm indicates significant compensation, risking ischemia or strain, requiring immediate action (e.g., slowing infusion, notifying physician). BP of 140/90 is improved, not critical. Headache and flushing are expected from vasodilation, less urgent. Tachycardia's potential to destabilize circulation, especially in severe hypertension, aligns with hydralazine's pharmacology'arteriolar relaxation prompts sympathetic response. This finding demands swift intervention to prevent cardiovascular collapse, making B the priority over manageable side effects.
The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
- A. Increased heart rate
- B. Increased blood vessel dilation
- C. Increased force of cardiac contractions
- D. Increased conduction of electrical impulses across the heart
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor that works by increasing the levels of cyclic adenosine monophosphate (cAMP) within cardiac myocytes. This leads to enhanced calcium influx into the cells, ultimately resulting in increased force of cardiac contractions (positive inotropic effect). This increased contractility helps improve cardiac output without necessarily increasing heart rate or affecting blood vessel dilation.
The specificity of the adrenergic blocking agents allows the clinician to select a drug to do what?
- A. Have the desired effect
- B. Multiply undesired effects
- C. Increase specificity with higher serum blood levels
- D. Improving concentration in the body
Correct Answer: A
Rationale: This specificity allows the clinician to select a drug that will have the desired therapeutic effects without the undesired effects that occur when the entire sympathetic nervous system is blocked. In general, however, the specificity of adrenergic blocking agents depends on the concentration of drug in the body. Most specificity is lost with higher serum drug levels. The nurse should understand the importance of drug specificity to ensure safe and effective administration.