Nursing Elites

1. A healthcare provider is reviewing a client's health record and notes that the client is experiencing episodes of hypokalemia. Which of the following medications should the healthcare provider identify as a cause of the client's hypokalemia?

• A. Captopril
• B. Lisinopril
• C. Furosemide
• D. Spironolactone

Correct answer: C

Rationale: Furosemide is a loop diuretic that acts on the kidneys to increase urine production. This increased urine output can lead to the excessive excretion of potassium, resulting in hypokalemia. Monitoring potassium levels and considering supplementation may be necessary when a patient is on furosemide to prevent or manage hypokalemia.

2. When educating a client starting a new prescription for metoprolol, which instruction should the nurse include?

• A. Check your pulse before taking the medication.
• B. Take the medication with food to increase absorption.
• C. Avoid sudden changes in position.
• D. Monitor your blood pressure regularly.

Correct answer: C

Rationale: The correct instruction for a client starting metoprolol is to avoid sudden changes in position. Metoprolol can cause dizziness due to its blood pressure-lowering effects, increasing the risk of falls and injury. Instructing the client to change positions slowly helps prevent orthostatic hypotension and related adverse events. Checking the pulse before taking the medication (Choice A) is not typically necessary for metoprolol. Taking the medication with food (Choice B) is not required for absorption and can be taken with or without food. Monitoring blood pressure regularly (Choice D) is essential for clients taking metoprolol, but avoiding sudden changes in position is more critical to prevent dizziness and falls.

3. A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?

• A. Reduced cardiac function
• B. First-pass effect
• C. Reduced hepatic function
• D. Increased gastric motility

Correct answer: C

Rationale: In older adults, reduced hepatic function can lead to prolonged effects of medications metabolized by the liver. This situation can result in increased drug levels in the body, causing drowsiness and other side effects. Adjusting the dosage of the hypnotic medication may be necessary to prevent such adverse effects in older adult clients. Choice A, reduced cardiac function, is not directly related to the metabolism of the medication and is unlikely to cause drowsiness. Choice B, first-pass effect, refers to the initial metabolism of a drug in the liver before it enters circulation, but it is not the cause of drowsiness in this scenario. Choice D, increased gastric motility, does not play a significant role in the metabolism of the medication and is not a likely cause of the client's drowsiness.

4. A client is taking oral Oxycodone and Ibuprofen in recommended doses. The nurse should identify that an interaction between these two medications will cause which of the following findings?

• A. A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of this medication.
• B. A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of this medication.
• C. An increase in the expected therapeutic effect of both medications.
• D. An increase in expected adverse effects for both medications.

Correct answer: C

Rationale: When Oxycodone, a narcotic analgesic, and Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), are taken together, they work synergistically to enhance the pain-relieving effects of both medications. These drugs act through different mechanisms, leading to a combined analgesic effect that is more effective than when used alone. Therefore, the interaction between Oxycodone and Ibuprofen results in an increase in the expected therapeutic effect of both medications.

5. A client is starting therapy with filgrastim. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Bone pain
• B. Constipation
• C. Tinnitus
• D. Dry mouth

Correct answer: A

Rationale: When a client is starting therapy with filgrastim, monitoring for bone pain is essential. Filgrastim can lead to increased bone marrow activity, resulting in bone pain as a common adverse effect. Instructing the client to monitor and report any bone pain promptly can help in managing this side effect effectively.

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