The correct answer is Choice B

Choice A rationale: Dantrolene is a direct-acting skeletal muscle relaxant that works by inhibiting calcium release from the sarcoplasmic reticulum in muscle cells, thereby reducing muscle contraction. It is not intended for as-needed use during acute spasms but requires consistent dosing to maintain therapeutic levels. Intermittent use undermines its pharmacokinetics and may lead to subtherapeutic effects. The half-life of dantrolene is approximately 8.7 hours, and steady-state levels are necessary for optimal spasticity control in multiple sclerosis.

Choice B rationale: Dantrolene’s therapeutic effect on muscle spasticity may take several weeks to manifest due to its mechanism of action involving gradual reduction in intracellular calcium availability. If no improvement is noted within 3 months, it may indicate inadequate response or the need for dosage adjustment. Monitoring for efficacy is essential, as prolonged use without benefit increases risk of hepatotoxicity. Liver function tests should be monitored regularly. Normal ALT levels are 7–56 units/L; elevations may signal toxicity.

Choice C rationale: Dantrolene is classified as pregnancy category C, indicating that risk to the fetus cannot be ruled out. Animal studies have shown adverse effects, and there are no adequate human studies confirming safety during pregnancy. Therefore, it is not considered safe without careful risk-benefit analysis. Teratogenicity and fetal toxicity are concerns due to its action on muscle fibers and potential systemic effects. Pregnant clients should consult their provider before initiating or continuing dantrolene therapy.

Choice D rationale: Dantrolene does not directly affect calcium levels in the bloodstream. Its mechanism involves inhibition of calcium release within muscle cells, not systemic calcium metabolism. Routine calcium monitoring is not required unless the client has a separate condition affecting calcium homeostasis. Normal serum calcium levels range from 8.5 to 10.5 mg/dL. The primary lab concern with dantrolene is hepatotoxicity, necessitating regular liver function tests, not calcium surveillance. This statement reflects a misunderstanding of the drug’s effects.

Step 1: Divide the total dosage needed by the strength of each tablet.

• 120 mg ÷ 40 mg/tablet = 3 tablets

Final Answer: 3 tablets

Choice A rationale:

1 cup (8oz) plain low-fat yogurt. This is incorrect choice. Yogurt is a high-protein food that can increase nausea and reduce the absorption of levodopa/carbidopa. According to the American Parkinson Disease Association, taking levodopa/carbidopa with a small, low-protein snack can help with nausea symptoms.

Choice B rationale:

1 cup (8oz) of applesauce. This is a correct choice. Applesauce is a low-protein, low-fiber food that can help reduce nausea and improve the absorption of levodopa/carbidopa. According to Drugs.com, taking levodopa/carbidopa with foods that have a high fiber content can delay the drug’s absorption into the body. Applesauce also contains natural sugars that can provide some energy and hydration to the client.

Choice C rationale:

1 cup (8 oz) cooked spinach. This is an incorrect choice. Spinach is a high-protein, high-fiber food that can increase nausea and decrease the absorption of levodopa/carbidopa. According to the Parkinson’s Foundation3, dietary protein can interfere with the absorption of levodopa by competing with the same transporter in the gut and the brain. High-fiber foods can also slow down the gastric emptying and reduce the drug’s availability.

Choice D rationale:

1 oz of cheddar cheese. This is an incorrect choice. Cheese is a high-protein, high-fat food that can increase nausea and decrease the absorption of levodopa/carbidopa. According to the Parkinson’s Foundation, dietary protein can interfere with the absorption of levodopa by competing with the same transporter in the gut and the brain. High-fat foods can also delay the gastric emptying and reduce the drug’s availability.

Choice A rationale:

Asking “Why don’t you want to take the medication?” can help the nurse understand the client’s concerns or fears about the medication. However, it may come across as confrontational.

Choice B rationale:

Saying “I always do what the doctor tells me to do” does not address the client’s concerns and imposes the nurse’s personal beliefs on the client.

Choice C rationale:

Asking “Tell me more about this decision” is an open-ended question that encourages the client to express their feelings and concerns, allowing the nurse to provide appropriate education and support.

Choice D rationale:

Telling the client “You won’t get better unless you take the medication” is a threatening statement that does not respect the client’s autonomy or feelings.

So, the correct answer is C, “Tell me more about this decision.”.

Step 1: Determine how many milligrams are in each milliliter of the suspension.

• Total milligrams ÷ Total milliliters
• 25 mg ÷ 5 mL = 5 mg/mL

Step 2: Determine how many milliliters are needed to administer 75 mg.

• Desired milligrams ÷ Milligrams per milliliter
• 75 mg ÷ 5 mg/mL = 15 mL

Step 1 is to determine the total volume to be infused in minutes. This is done by multiplying the total volume by the drop factor: (1000 mL ÷ 480 min) × 15 gtt/mL = 31.25 gtt/min.

Choice A rationale:

The client should indeed notify their provider before taking any other medications, as phenytoin can interact with many other drugs. This statement does not indicate a need for further teaching.

Choice B rationale:

Regular dental appointments are important as phenytoin can cause gum hyperplasia. This statement does not indicate a need for further teaching.

Choice C rationale:

This statement indicates a misunderstanding. Phenytoin is used to control seizures, not cure them. The client should not stop taking the medication when their seizures stop.

Choice D rationale:

Phenytoin can be taken with or without food, but it should be taken consistently in the same manner. This statement does not indicate a need for further teaching.

So, the correct answer is C, after analyzing all choices.

Choice A rationale:

Risperidone can indeed increase triglyceride levels. The nurse should monitor this.

Choice B rationale:

Risperidone is more likely to cause weight gain, not weight loss. This is not a common adverse effect.

Choice C rationale:

Risperidone does not typically elevate blood pressure. This is not a common adverse effect.

Choice D rationale:

Risperidone does not typically decrease blood glucose levels. This is not a common adverse effect.

So, the correct answer is A, after analyzing all choices.

Choice A rationale:

The client should maintain a normal fluid intake while taking lithium, not limit it to 800 ounces per day.

Choice B rationale:

Lithium can be taken with or without food. This instruction is not necessary.

Choice C rationale:

It can indeed take up to 3 weeks to see the full effects of lithium. This is a correct instruction.

Choice D rationale:

The client should maintain a normal sodium diet while taking lithium, not a low-sodium diet.

So, the correct answer is C, after analyzing all choices.

Choice A rationale:

Withholding the dose if having a fine hand tremor is not recommended. Hand tremors are a common side effect of lithium, but they can be managed by adjusting the dose.

Choice B rationale:

Avoiding foods with a high tyramine content is not necessary for lithium users. This dietary restriction is typically associated with certain antidepressants, not lithium.

Choice C rationale:

Limiting daily fluid intake is incorrect. Lithium can cause increased thirst and urination, so it’s important to maintain adequate hydration.

Choice D rationale:

Following a low-sodium diet is not advised. Both salt and fluid can affect the levels of lithium in your blood, so it’s important to consume a steady amount every day.

So, the correct answer is, none of the above.