Adalimumab is a tumor necrosis factor alpha (TNF-alpha) inhibitor. This class of drugs suppresses response to TNF-alpha, a potent pro-inflammatory cytokine. Inhibition of folic acid metabolism is the method of action of methotrexate. Reversible inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) is the mechanism of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Rheumatoid arthritis drugs such as rituximab, and almost all drugs that end in -mab, including adalimumab function as monoclonal antibodies.

The correct answer is "acetaminophen." This is the correct answer because acetaminophen, also known as Tylenol, is initially metabolized into a hepatotoxic intermediate (it transiently becomes a reactive oxygen species, which can cause liver hepatotoxicity). As such, in patients who already have pre-existing liver disease who are already more prone to liver injury from substances and diseases that affect the liver, it is prudent to avoid medications like acetaminophen that have a known potential to cause liver damage.

Meloxicam, ibuprofen, naproxen, and ketorolac are all examples of non-steroidal anti-inflammatory drugs (NSAIDs). These medications have the potential to cause renal damage or gastrointestinal damage if used in excess, but do not have the known hepatotoxic properties that acetaminophen does.

The correct answer is "insomnia," as steroids are known to increase patients' vigilance and energy levels, thereby frequently making it difficult for patients to fall asleep and/or stay asleep while taking their steroid medication. The other choices are incorrect. Decreased appetite is not a side effect of taking steroid medications. Patients on steroids often have increased appetite. Hyponatremia and hyperkalemia both are not side effects of taking steroid medications. Hypernatremia and hypokalemia are more common side effects of steroids. Hypertension, rather than hypotension is a known side effect of steroid use.

The correct answer is "meperidine." Meperidine, a potent opioid analgesic, also known as Demerol, is one of the only opioids that produces dilated pupils, rather than constricted, "pinpoint" pupils. A way to remember this is to remember the phrase, "Demerol Dilates." The other choices are incorrect. Acetaminophen has no known effect on pupil size. Morphine, oxycodone, and hydromorphone, all opioid analgesics, are known to constrict the pupils.

The correct answer is "NSAIDs." This is the correct answer because NSAIDs are known to be irritants of the gastrointestinal tract, and prolonged and/or extensive use of NSAIDs can increase the risk of developing gastrointestinal ulcers, as well as consequent gastrointestinal bleeds in the setting of ulcers. Given this patient's medical history, which already contains multiple gastrointestinal bleeds and peptic ulcer disease, NSAIDs should be used very, very carefully, if at all, in this patient.

The other choices are incorrect. Acetaminophen is not known to increase the risk of gastrointestinal bleeding or peptic ulcer formation. Morphine, oxycodone, and hydromorphone are all opioid analgesics and are not known to increase the risk of gastrointestinal bleeding or peptic ulcer formation.

It is essential for the nurse to know the onset, peak, and duration of actions for all types of insulin. Rapid-acting insulins lispro and aspart have an onset between 10-30 minutes, peak between 30 min to 3 hours, and have a duration of 3-6 hours. Regular insulin has an onset between 30-60 min, peaks between 1-5 hours, and lasts 6-10 hours. Intermediate-acting insulins isophane (NPH) has an onset between 1-2 hours, peaks between 6-12 hours, and lasts 16-24 hours. Very long-acting insulin glargine has an onset between 3-4 hours, does not peak because it works continuously, and lasts 24 hours.

Albuterol, terbutaline, and salmeterol are all beta-2 adrenergic agonists. Beta-2 adrenergic agonists stimulate beta-2 adrenergic receptors, causing smooth muscle relaxation in the bronchial passages.

Tiotropium (trade name Spiriva) is an anticholinergic bronchodilators.

Fluticasone (trade name Flovent) is a synthetic glucocorticoid used in the treatment of asthma and allergic rhinitis. 

Montelukast is a leukotriene inhibitor. It acts by antagonism of the leukotriene receptor sites in bronchial wall smooth muscle to prevent wheezing, chest tightness, and coughing caused by asthma, and to treat other respiratory issues to promote proper ventilation.

Macrolides, streptogramins, and clindamycin all work by inhibition of the 50S subunit of bacterial ribosomes. Tetracyclines have a similar mechanism of action, but instead affect the 30S unit of bacterial ribosomes.