Nursing Elites

1. A client has a new prescription for Adalimumab for Rheumatoid Arthritis. Based on the route of administration of Adalimumab, which of the following should the nurse plan to monitor?

• A. The vein for thrombophlebitis during IV administration.
• B. The subcutaneous site for redness following injection.
• C. The oral mucosa for ulceration after oral administration.
• D. The skin for irritation following removal of a transdermal patch.

Correct answer: B

Rationale: Adalimumab is administered subcutaneously. Injection-site redness and swelling are common adverse effects. Therefore, the nurse should monitor the subcutaneous site for redness following the injection to assess for any potential issues or reactions.

2. When educating a client with a new prescription for Losartan, which instruction should the nurse provide?

• A. Avoid consuming grapefruit juice.
• B. Take this medication with a full glass of water.
• C. Take this medication with food.
• D. Monitor for signs of dehydration.

Correct answer: D

Rationale: The correct answer is to instruct the client to monitor for signs of dehydration when taking Losartan. Losartan can lead to dehydration, so it is crucial for the client to watch out for symptoms like dry mouth, increased thirst, and reduced urine output. Monitoring for these signs can help prevent complications associated with dehydration while taking this medication. Choices A, B, and C are incorrect because Losartan is not known to have interactions with grapefruit juice, does not require a specific amount of water for intake, and can be taken with or without food.

3. A healthcare professional is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the healthcare professional adjust the manual IV infusion to deliver?

• A. 22 gtt/min
• B. 24 gtt/min
• C. 20 gtt/min
• D. 18 gtt/min

Correct answer: A

Rationale: To determine the flow rate in drops per minute (gtt/min), you can use the formula: (Volume in mL x Drop factor) / Time in minutes = Flow rate in gtt/min. In this case, it would be (100 mL x 10 gtt/mL) / 45 min = 22 gtt/min. Therefore, the healthcare professional should adjust the manual IV infusion to deliver 22 gtt/min. Choice B, 24 gtt/min, is incorrect as it results from a miscalculation. Choices C and D, 20 gtt/min and 18 gtt/min respectively, are also incorrect calculations based on the given parameters.

4. An older adult client has a new prescription for Digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for Digoxin toxicity?

• A. Phenytoin
• B. Verapamil
• C. Warfarin
• D. Aluminum hydroxide

Correct answer: B

Rationale: Verapamil, a calcium-channel blocker, can increase digoxin levels, leading to toxicity. When given together, the digoxin dosage may need adjustment, and the nurse should closely monitor the client's digoxin levels to prevent toxicity symptoms such as nausea, vomiting, visual disturbances, and arrhythmias. The other choices, Phenytoin, Warfarin, and Aluminum hydroxide, do not significantly interact with Digoxin to cause toxicity. Phenytoin may reduce Digoxin levels, while Warfarin and Aluminum hydroxide have minimal interactions with Digoxin.

5. When educating a patient on taking levothyroxine, a drug used to balance thyroid activity, what should you include in their education?

• A. Don't disregard side effects and consult your healthcare professionals
• B. Take this at the same time every day
• C. Thyroid tests are necessary while taking this drug
• D. It is not recommended to take this drug if you have recently had a myocardial infarction

Correct answer: B

Rationale: The correct answer is to take levothyroxine at the same time every day. Consistent timing helps maintain stable thyroid levels, ensuring the effectiveness of the medication. It is important to establish a routine to optimize its therapeutic benefits. Choice A is incorrect as patients should not ignore side effects but should consult healthcare professionals if they experience any. Choice C is incorrect because thyroid tests may still be necessary to monitor thyroid function while on levothyroxine. Choice D is incorrect as it is not advisable to take levothyroxine if the patient has recently had a myocardial infarction without consulting their healthcare provider.

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