NR-293 Pharmacology for Nursing Practice - Set 4 - Part 3

Correct Answer: "I plan to start with sauerkraut and pickled herring."

Sauerkraut and pickled herring are both on the restricted list, since fermenting and pickling raise tyramine sharply. Eating them while monoamine oxidase is inhibited can drive blood pressure into crisis. Option a is incorrect because fresh poultry and fresh vegetables sit squarely in the permitted column. A meal built from unaged, unprocessed food is exactly what this client should be choosing. Option c is incorrect because declining wine shows the client grasped the beverage restriction. Both wine and beer, even the alcohol free versions, must be avoided, so sparkling water is a sound substitution. Option d is incorrect because avoiding soy sauce reflects correct understanding rather than a gap. Fermented soy products, including miso and soy sauce, belong on the avoid list, so skipping them is right.

Correct Answer: Reduced swelling in the affected joints

Ibuprofen blocks cyclooxygenase in peripheral tissue, so prostaglandin driven inflammation falls and joints swell less. Acetaminophen works centrally and relieves pain and fever without touching the inflammatory process at the joint. Option a is incorrect because no analgesic rebuilds eroded cartilage or bone. Ibuprofen quiets the chemical mediators that produce heat, swelling and pain, leaving the underlying disease process to be treated by other therapy. Option b is incorrect because the drug removes gastric protection rather than adding it. Blocking the housekeeping enzyme cuts mucus and bicarbonate production, which is why ulceration and bleeding head the list of NSAID hazards. Option c is incorrect because platelet clumping is suppressed, not increased. Loss of thromboxane activity prolongs bleeding time, so bruising and oozing at puncture sites are the findings that should prompt a closer look.

Correct Answer: Ethosuximide, a thalamic calcium channel blocker

The description is a classic absence seizure. Ethosuximide suppresses the thalamic T type calcium currents that drive these episodes and is the drug of choice for uncomplicated childhood absence epilepsy. Option a is incorrect because carbamazepine treats focal and tonic clonic seizures well yet can make absence episodes more frequent. Prescribing it here would worsen the very staring spells that brought the child to the clinic. Option b is incorrect because hydantoins share carbamazepine's weakness against absence and myoclonic seizure types. Phenytoin also brings gingival hyperplasia and hirsutism, effects that drive adolescents to stop taking a drug that was not helping anyway. Option d is incorrect because gabapentin serves mostly as an add on for focal seizures and far more often for neuropathic pain. It has no role in absence epilepsy and can worsen myoclonic activity.

Correct Answer: "Cottage cheese on fresh fruit makes a fine lunch for me."

Cottage cheese and cream cheese stay off the tyramine restricted list, and fresh fruit that is not overripe is equally safe. Aged, fermented, cured and spoiled foods are the ones that must go. Option b is incorrect because aging concentrates tyramine, and cheddar sits near the top of the forbidden list. Portion size offers no protection once monoamine oxidase can no longer break the amine down. Option c is incorrect because alcohol free and reduced alcohol beers are restricted just as ordinary beer is. Tyramine forms during brewing and fermentation, so removing the alcohol leaves the hazardous compound untouched. Option d is incorrect because dry cured sausages such as pepperoni and hard salami are classic tyramine sources. Cooking does not destroy the amine that curing has already produced in the meat.

Correct Answer: Report fever, sore throat, or mouth ulcers

Clozapine can destroy neutrophils, so any sign of infection matters. Fever, sore throat, and mouth ulcers prompt an immediate neutrophil count, and the client keeps every scheduled blood draw during therapy. Option a is incorrect because dry mouth is a routine anticholinergic complaint managed with sips of water and sugar free candy. It signals nothing about the bone marrow and never justifies an urgent telephone call. Option b is incorrect because heavy night time drooling is one of clozapine's odd signature effects. Sialorrhea is socially distressing and worth discussing at a visit, yet it does not threaten the client's life. Option c is incorrect because gradual weight gain belongs on the metabolic monitoring schedule with quarterly weights and yearly lipids. A few pounds calls for diet and activity counselling, not an emergency contact.

Correct Answer: The on off phenomenon

Abrupt, unpredictable swings between mobility and sudden freezing that bear no relation to dose timing define the on off phenomenon. Wearing off, by contrast, is predictable and arrives as the next dose approaches. Option a is incorrect because wearing off follows the clock. Benefit fades near the end of each dosing interval as the therapeutic window narrows, and shortening the interval or adding a COMT inhibitor smooths it out. Option c is incorrect because dyskinesia is excess movement, not absent movement. Writhing, twisting and head bobbing at the height of a dose signal too much dopaminergic stimulation, the mirror image of the freezing described here. Option d is incorrect because that label applies to parkinsonism caused by dopamine blocking agents such as antipsychotics or metoclopramide. This client has idiopathic disease of long standing and a complication of his own therapy.

Correct Answer: New agitation along with talk of dying

Antidepressants carry a boxed warning for emerging suicidal thinking in clients under twenty five, greatest in the first weeks. Agitation paired with talk of dying demands same day evaluation rather than telephone reassurance. Option a is incorrect because gastrointestinal upset is the most common early complaint with this class and usually fades within a week or two. Taking the dose with food generally settles it without a clinic visit. Option b is incorrect because headache appears often when serotonin reuptake inhibition begins and responds to simple analgesia. A symptom that a common pain reliever controls does not signal the danger the warning targets. Option c is incorrect because appetite shifts belong to the expected adjustment period and are monitored at the next scheduled visit. Weight is tracked over time, so a single light supper carries no urgency.

Correct Answer: Hydrochlorothiazide for newly diagnosed hypertension

Thiazide diuretics increase proximal reabsorption of lithium, so the serum level climbs even though the dose has not changed. The nurse questions the order and expects closer level monitoring if it is kept. Option a is incorrect because acetaminophen is the analgesic recommended for clients on lithium. Unlike ibuprofen and naproxen it leaves renal lithium clearance alone, so an occasional headache dose creates no interaction worth a call. Option c is incorrect because levothyroxine treats a problem lithium itself creates. Hypothyroidism and goiter develop in many long term users, and the standard approach adds thyroid replacement instead of stopping the mood stabiliser. Option d is incorrect because polyethylene glycol acts inside the bowel lumen and is not absorbed in amounts that alter renal handling of lithium. Constipation relief carries none of the sodium loss that drives levels upward.

Correct Answer: Acetaminophen given by mouth

Step one of the ladder treats mild pain with a nonopioid such as acetaminophen or an NSAID. Reserving opioids for moderate and severe ratings avoids sedation and constipation the client does not need. Option b is incorrect because combination products belong to step two, where a weak opioid is added for moderate pain. Starting one for a rating of two exposes the client to opioid effects without added benefit. Option c is incorrect because intravenous hydromorphone is a strong opioid reserved for severe pain at step three. It is five to seven times more potent than morphine and would oversedate a client with mild discomfort. Option d is incorrect because the fentanyl patch is limited to opioid tolerant clients with stable chronic pain. Its onset takes many hours, so it treats neither this rating nor any acute postprocedure discomfort.

Correct Answer: "I will wear a hat, sleeves, and sunscreen outdoors."

Chlorpromazine causes photosensitivity and can discolour the skin, so covering up and using sunscreen prevents severe burning. Heat tolerance is also impaired by this class, making shade and fluids part of the same plan. Option a is incorrect because stopping an antipsychotic for a week risks a return of hallucinations and delusions. Sun safety is handled with clothing and sunscreen, never by interrupting a drug that holds symptoms in check. Option b is incorrect because deliberate sun exposure does not build any protection against a drug induced reaction. The skin burns faster than usual on this medication, and prolonged direct sun invites a painful injury. Option d is incorrect because tanning beds deliver the same ultraviolet light that triggers the reaction. Choosing one before travel would produce a burn ahead of the trip rather than any useful preparation.