Pharmacology

Why B is correct

The chewable tablets contain aspartame, a sweetener that supplies phenylalanine, so the nurse alerts the prescriber. Phenylketonuria is an inherited inability to break down phenylalanine, a protein building block. Montelukast, a leukotriene receptor antagonist, is a daily asthma tablet that blocks a chemical that swells the airways.

Why the other options are wrong

• A — "They are best given in the morning": For asthma, montelukast is given once daily in the evening.
• C — "They are taken on an empty stomach": Montelukast may be given with or without food.
• D — "They ease wheezing within minutes": Montelukast does not stop a sudden attack; a reliever inhaler does. Preventing attacks is part of what it offers, but that comes from steady daily use, not from one dose.

Why D is correct

Pressing the inner canthus occludes the nasolacrimal duct, limiting drainage of the drop into the nasal mucosa and reducing how much of the beta-blocker reaches systemic circulation — the key safety concern given the patient's bradycardia.

Why the other options are wrong

• A — increase the drop's contact time with the corneal surface: contact time is extended by keeping the eyelid closed, not by canthal pressure, whose purpose is limiting systemic absorption.
• B — prevent reflex tearing from washing the medication away: canthal pressure occludes the duct; it does not act on the tearing reflex.
• C — reduce local stinging and irritation caused by the drop: canthal pressure has no effect on local stinging; its purpose is systemic protection, not comfort.

Why B is correct

The nurse verifies when his last dose was given and compares it with the ordered frequency. An as-needed (PRN) order means the drug is given only when the client needs it, so the nurse must make sure enough time has passed.

Why the other options are wrong

• A — "How bad his back pain is right now": Pain level does not show whether another dose is allowed yet. Rating pain is standard practice before an as-needed pain reliever, but a dose given too soon is an error however bad the pain is.
• C — "Whether he has eaten since breakfast": Food does not change whether this dose is due. Acetaminophen is a common pain and fever reliever.
• D — "His temperature at the last check": Temperature does not show whether the dose is due, and here the drug is ordered for pain.

Why C is correct

With microdrip tubing (60 gtt/mL), drops per minute numerically equal milliliters per hour. One liter over 12 hours is about 83 mL/hr, so the rate is 83 gtt/min.

Why the other options are wrong

• A — 60 gtt/min: this simply repeats the drop factor rather than calculating the actual hourly rate.
• B — 120 gtt/min: this doubles the correct rate.
• D — 42 gtt/min: this applies a macrodrip-style calculation, which does not match microdrip's 1:1 gtt/min-to-mL/hr relationship.

Why D is correct

Dry mouth and daytime drowsiness are the side effects he is most likely to notice: about 40 in 100 people on clonidine get a dry mouth and about 33 in 100 get drowsy. Clonidine acts on the brain to quiet the nerve signals that narrow blood vessels, which lowers blood pressure. The nurse warns him to take care with driving and alcohol.

Why the other options are wrong

• A — "A dry cough and a change in taste": These are not common clonidine effects. A dry cough is typical of ACE inhibitors, blood pressure drugs ending in -pril.
• B — "Ankle swelling and facial flushing": These are not common clonidine effects; they follow calcium channel blockers, which widen blood vessels.
• C — "A headache and a fast heartbeat": Each is uncommon on clonidine. Both can occur with it, but dry mouth and drowsiness are far more frequent.