A provider has prescribed quetiapine 50 mg PO, divided equally every 12 hours for 3 days. The available medication is quetiapine 25 mg tablets.

How many tablets should the nurse administer per dose on the third day?

Choice A rationale

Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people

with delayed stomach emptying, and to help with gastroesophageal reflux disease. The antiemetic action of metoclopramide is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system — this action prevents nausea and vomiting triggered by most stimuli.

Choice B rationale

While metoclopramide does have an effect on the muscles of the gastrointestinal tract, it does not work by relaxing them. Instead, it works by blocking dopamine receptors, which in turn stimulates motility in the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. This increased motility helps to speed up the rate at which the stomach empties into the intestines.

Choice C rationale

Metoclopramide does not work by decreasing gastric acid secretions. In fact, one unique property of this drug is that it does not increase gastric acid secretion. Its primary mechanism of action is to block dopamine receptors, thereby increasing muscle contractions in the upper digestive tract.

Choice D rationale

This is correct. Metoclopramide enhances gastric emptying. It is used to treat conditions like gastroesophageal reflux disease and diabetic gastroparesis, where delayed gastric emptying is a problem. By blocking dopamine receptors, metoclopramide increases muscle contractions in the upper digestive tract, speeding up the rate at which the stomach empties into the intestines.

Choice A rationale

Phosphate levels are not directly affected by spironolactone. Spironolactone is a potassium- sparing diuretic and does not typically affect phosphate levels.

Choice B rationale

Decreased potassium level is not typically expected in a patient taking spironolactone. Spironolactone is a potassium-sparing diuretic, meaning it can actually lead to increased potassium levels. However, in the context of liver failure and ascites, other factors may influence potassium levels.

Choice C rationale

Chloride levels are not directly affected by spironolactone. Spironolactone primarily affects the balance of potassium and sodium in the body.

Choice D rationale

Sodium levels could potentially be decreased in a patient taking spironolactone, as it can cause the body to lose sodium. However, in the context of liver failure and ascites, sodium levels are often carefully managed.