Nursing Elites

1. A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

• A. Dilute the available heparin in 250ml of normal saline solution prior to IV administration
• B. Advise the pharmacy on the need to deliver a vial of heparin to the nursing unit immediately
• C. Calculate and administer the equivalent dose of the available low molecular weight heparin
• D. Request a prescription to change the route of administration and use the available heparin

Correct answer: B

Rationale: In this scenario, the nurse should contact the pharmacy to obtain the correct heparin formulation as the prescription calls for heparin 1,000 units IV STAT. Low molecular weight heparin is not the same as unfractionated heparin, and therefore, the nurse should not administer the available low molecular weight heparin without first obtaining the correct medication. Diluting the available heparin, calculating an equivalent dose, or changing the route of administration would not address the discrepancy between the prescribed heparin and the available low molecular weight heparin.

2. A client has metoprolol prescribed. The nurse should reinforce instructions that this medication has which potential adverse effect?

• A. Anxiety
• B. Tachycardia
• C. Sexual dysfunction
• D. Acute renal failure

Correct answer: C

Rationale: The correct answer is C: Sexual dysfunction. Metoprolol, a beta-blocker, can cause sexual dysfunction as an adverse effect. It is important for the nurse to educate the client about this potential side effect. Choice A is incorrect because metoprolol can cause depression, not anxiety. Choice B is incorrect as tachycardia is not an adverse effect of metoprolol; instead, it can lead to bradycardia. Choice D is incorrect because acute renal failure is not typically associated with the use of beta-blockers.

3. The practical nurse administered carbidopa-levodopa to a client diagnosed with Parkinson's disease. Which outcome by the client would indicate a therapeutic response?

• A. Decreased blood pressure
• B. Lessening of tremors
• C. Increased salivation
• D. Increased attention span

Correct answer: B

Rationale: The correct answer is B: Lessening of tremors. Carbidopa-levodopa increases the amount of levodopa to the CNS, providing more dopamine to the brain. Increased dopamine levels help alleviate Parkinson's symptoms such as tremors, involuntary movements, and gait abnormalities. Choices A, C, and D are incorrect as carbidopa-levodopa is not expected to have a direct effect on blood pressure, salivation, or attention span in the context of treating Parkinson's disease.

4. A client is prescribed cyclobenzaprine for muscle spasms. The nurse should instruct the client to avoid which substance while taking this medication?

• A. Alcohol
• B. Caffeine
• C. Nicotine
• D. Dairy products

Correct answer: A

Rationale: The correct answer is A: Alcohol. When taking cyclobenzaprine, it is important to avoid alcohol as it can potentiate the central nervous system depressant effects of the medication. This interaction can lead to increased drowsiness, dizziness, and impaired coordination. Therefore, it is essential for the client to refrain from alcohol consumption while on cyclobenzaprine to prevent these adverse effects and ensure their safety. Choices B, C, and D are incorrect because caffeine, nicotine, and dairy products do not have significant interactions with cyclobenzaprine. While caffeine and nicotine may have stimulant effects that could theoretically counteract some of the sedative effects of cyclobenzaprine, they are not contraindicated. Dairy products, on the other hand, do not interact with cyclobenzaprine and can be consumed safely.

5. A client with a history of stroke is prescribed clopidogrel. The nurse should monitor the client for which potential side effect?

• A. Bleeding
• B. Bruising
• C. Nausea
• D. Headache

Correct answer: A

Rationale: Clopidogrel is an antiplatelet medication that works to prevent blood clots, but it can also increase the risk of bleeding. Therefore, the nurse should monitor the client for signs of bleeding, such as easy bruising, prolonged bleeding from cuts, blood in urine or stool, or unusual bleeding from the gums. Prompt identification and management of bleeding are crucial to prevent complications. Choices B, C, and D are incorrect because while bruising and other symptoms can occur as a result of bleeding, they are not the primary side effect to monitor for with clopidogrel. Nausea and headache are less commonly associated with clopidogrel use compared to bleeding.

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