Nursing Elites

1. When assessing a client taking Gemfibrozil, which of the following findings should the nurse identify as an adverse reaction to the medication?

• A. Mental status changes
• B. Tremor
• C. Jaundice
• D. Pneumonia

Correct answer: C

Rationale: Jaundice is an adverse reaction that can occur in clients taking Gemfibrozil due to the potential development of liver impairment. Other symptoms of liver impairment may include anorexia and upper abdominal discomfort. Monitoring for signs of jaundice is crucial to detect and manage adverse effects of the medication promptly. Mental status changes (choice A) are not commonly associated with Gemfibrozil use. Tremor (choice B) is not a typical adverse reaction of Gemfibrozil. Pneumonia (choice D) is not directly linked to Gemfibrozil use but can be a complication in some cases.

2. When a client is receiving treatment with methotrexate, which supplement should the nurse instruct the client to take?

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

Correct answer: A

Rationale: Folic acid supplementation is crucial for clients undergoing methotrexate treatment because methotrexate functions as a folic acid antagonist. By supplementing with folic acid, the risk of methotrexate toxicity can be minimized, improving the treatment's effectiveness and safety. Vitamin D, calcium, and iron are not specifically recommended in conjunction with methotrexate therapy and may not provide the same protective benefits as folic acid.

3. A client with migraine headaches is starting prophylaxis therapy with Propranolol. Which finding in the client's history should the nurse report to the provider?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with first-degree heart block due to its negative inotropic and chronotropic effects. The nurse should report this finding to the provider to consider an alternative therapy to prevent potential worsening of cardiac conduction abnormalities. Choices A, B, and C are not directly contraindications to Propranolol therapy for migraine headaches and do not pose immediate risks that would require reporting to the provider.

4. A client is receiving treatment with etoposide. Which of the following findings should the nurse monitor?

• A. Hypotension
• B. Hyperkalemia
• C. Hyperglycemia
• D. Hypertension

Correct answer: A

Rationale: Etoposide is associated with hypotension as a common adverse effect. Therefore, the nurse should closely monitor the client for signs and symptoms of hypotension while receiving this medication, such as dizziness, light-headedness, or low blood pressure readings. Prompt recognition and management of hypotension can help prevent complications and ensure the client's safety during treatment with etoposide.

5. A client with congestive heart failure taking digoxin refused breakfast and is complaining of nausea and weakness. Which action should the nurse take first?

• A. Check the client's vital signs.
• B. Request a consult with a dietitian.
• C. Suggest that the client rests before eating the meal.
• D. Request an order for an antiemetic.

Correct answer: A

Rationale: The nurse should check the client's vital signs first because nausea and weakness can be signs of digoxin toxicity. Vital signs can provide immediate information on the client's condition and help guide further interventions. Monitoring vital signs will allow the nurse to assess for bradycardia, a common sign of digoxin toxicity. Requesting a dietitian consult (choice B) may be necessary but addressing the immediate concern of toxicity is the priority. Suggesting rest before eating (choice C) may not address the underlying issue of digoxin toxicity. Requesting an antiemetic (choice D) can be considered later but is not the initial action needed in this situation.

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