Nursing Elites

1. A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:

• A. Should always be taken with food or antacids
• B. Should be double-dosed if one dose is forgotten
• C. Causes orange discoloration of sweat, tears, urine, and feces
• D. May not be discontinued independently if symptoms are gone in 3 months

Correct answer: C

Rationale: Rifampin causes orange-red discoloration of body secretions, including sweat, tears, urine, and feces. It can also permanently stain soft contact lenses. It is essential to take rifampin exactly as directed and not discontinue it without consulting the healthcare provider.

2. A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the client indicates a need for further teaching?

• A. I will avoid foods high in vitamin K.
• B. I will take the medication at the same time each day.
• C. I will use an electric razor to shave.
• D. I will take aspirin if I have a headache.

Correct answer: D

Rationale: Clients taking warfarin (Coumadin) should avoid aspirin unless prescribed by their healthcare provider, as it can increase the risk of bleeding. The other statements are correct and do not indicate a need for further teaching. Taking aspirin along with warfarin can potentiate the anticoagulant effects of warfarin, leading to an increased risk of bleeding complications.

3. When administering etanercept (Enbrel) to a client with rheumatoid arthritis for 3 weeks, what is the most important assessment for the nurse to perform?

• A. Assessing the injection site for itching and edema
• B. Monitoring white blood cell counts and platelet counts
• C. Evaluating for fatigue and joint pain in the client
• D. Checking for a metallic taste in the mouth and loss of appetite

Correct answer: B

Rationale: The priority when administering etanercept (Enbrel) to a client with rheumatoid arthritis is to monitor white blood cell counts and platelet counts. Etanercept can lead to infections and pancytopenia, making it crucial to assess for changes in these blood parameters to detect any potential complications early on.

4. A client is receiving meperidine (Demerol) for pain management. Which assessment finding requires immediate action?

• A. Constipation
• B. Drowsiness
• C. Respiratory rate of 10 breaths per minute
• D. Nausea

Correct answer: C

Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a severe side effect of meperidine (Demerol) that necessitates immediate intervention to prevent further complications. Constipation, drowsiness, and nausea are common but less urgent side effects that do not pose an immediate life-threatening risk. Respiratory depression can lead to respiratory arrest and must be addressed promptly to ensure the client's safety and well-being.

5. When reviewing laboratory results for a client receiving tacrolimus (Prograf), which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication?

• A. Blood glucose of 200 mg/dL
• B. Potassium level of 3.8 mEq/L
• C. Platelet count of 300,000 cells/mm³
• D. White blood cell count of 6000 cells/mm³

Correct answer: A

Rationale: An elevated blood glucose level of 200 mg/dL indicates an adverse effect of tacrolimus. This finding suggests hyperglycemia, which is a known adverse effect of the medication. Other potential adverse effects of tacrolimus include neurotoxicity and hypertension. Monitoring blood glucose levels is crucial to detect and manage this adverse effect promptly. Choices B, C, and D are not directly associated with adverse effects of tacrolimus. Potassium, platelet count, and white blood cell count are important parameters to monitor for other reasons but not specifically for detecting adverse effects of tacrolimus.

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