Nursing Elites

1. A healthcare professional is caring for a client who is prescribed Digoxin. Which of the following findings should the healthcare professional monitor to assess for potential toxicity?

• A. Bradycardia
• B. Hypertension
• C. Hypoglycemia
• D. Hypercalcemia

Correct answer: A

Rationale: The correct answer is A: Bradycardia. Bradycardia is a common sign of Digoxin toxicity. Digoxin can cause bradycardia due to its effects on the heart's electrical conduction system. Monitoring the client's heart rate regularly is essential to detect and manage toxicity promptly. Choice B, Hypertension, is incorrect as Digoxin toxicity typically presents with bradycardia and not hypertension. Choices C and D, Hypoglycemia and Hypercalcemia, are also incorrect as they are not typically associated with Digoxin toxicity.

2. When teaching a client with cancer who has a prescription for methotrexate, which supplement should the nurse instruct the client to take?

• A. Folic acid
• B. Magnesium
• C. Vitamin D
• D. Iron

Correct answer: A

Rationale: The correct answer is folic acid. Methotrexate is a folic acid antagonist, so instructing the client to take folic acid helps reduce the risk of methotrexate toxicity by providing additional folic acid that the medication may deplete. Magnesium (choice B), Vitamin D (choice C), and Iron (choice D) are not the correct supplements to instruct the client to take with methotrexate.

3. A healthcare provider is preparing to administer dextrose 5% in water (D5W) 750 mL IV to infuse over 6 hr. How many mL/hr should the IV pump be set to deliver?

• A. 125 mL/hr
• B. 100 mL/hr
• C. 150 mL/hr
• D. 200 mL/hr

Correct answer: A

Rationale: To calculate the flow rate, divide the total volume by the total time: (750 mL / 6 hr) = 125 mL/hr. Therefore, the IV pump should be set to deliver 125 mL/hr to infuse dextrose 5% in water (D5W) over 6 hours. Choice B, 100 mL/hr, is incorrect as it does not match the correct calculation. Choice C, 150 mL/hr, is incorrect as it is higher than the calculated flow rate. Choice D, 200 mL/hr, is incorrect as it is also higher than the calculated flow rate.

4. What instruction should the healthcare provider include to minimize an adverse effect of Clomipramine for OCD in an adolescent client?

• A. Wear sunglasses when outdoors.
• B. Check your temperature daily.
• C. Take this medication in the morning.
• D. Add extra calories to your diet.

Correct answer: A

Rationale: The correct answer is A: 'Wear sunglasses when outdoors.' To minimize the anticholinergic effect of Clomipramine, the client should wear sunglasses when outdoors to reduce photophobia. This adverse effect is common with tricyclic antidepressant (TCA) use. Choices B, C, and D are incorrect. Checking temperature daily, timing of medication intake, or adding extra calories to the diet are not directly related to minimizing adverse effects of Clomipramine.

5. Which drug undergoes extensive first-pass hepatic metabolism?

• A. Heparin
• B. Insulin
• C. Propranolol
• D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

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