Nursing Elites

1. A client is prescribed amitriptyline for depression. The practical nurse (PN) should monitor for which potential side effect?

• A. Insomnia
• B. Weight loss
• C. Dry mouth
• D. Increased appetite

Correct answer: D

Rationale: The correct answer is 'D: Increased appetite.' Amitriptyline, a tricyclic antidepressant, is known to commonly cause increased appetite, leading to weight gain. Monitoring for increased appetite is crucial as it can impact the client's overall health and well-being. Choice A, 'Insomnia,' is less likely as amitriptyline is more associated with sedative effects. Choice B, 'Weight loss,' is incorrect as weight gain is a more common side effect. Choice C, 'Dry mouth,' is a potential side effect of amitriptyline, but it is not directly related to increased appetite, which is the primary concern in this case.

2. Which assessment finding requires nursing intervention prior to the administration of medication?

• A. Apical pulse heard best at the pulmonic site
• B. Irregular apical pulse rhythm
• C. Presence of a systolic heart murmur
• D. Apical pulse rate of 50 beats/minute

Correct answer: D

Rationale: An apical pulse rate of 50 beats/minute indicates bradycardia, a heart rate below the normal range, which requires immediate nursing intervention before administering medication to address the potential impact of the bradycardia on the patient's overall condition.

3. A client with a diagnosis of generalized anxiety disorder is prescribed alprazolam. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Alprazolam, a medication commonly used to treat anxiety disorders, can cause drowsiness as a common side effect. Clients should be advised not to drive or operate heavy machinery until they know how the medication affects them to ensure their safety.

4. The client is receiving vancomycin, and the nurse plans to draw blood for a peak and trough to determine... the best timing for these levels?

• A. Midway through administration of the IV dose and 30 minutes before the next
• B. Two hours after completion of the IV dose and 30 minutes before the next
• C. Two hours after completion of the IV dose and one hour before the next
• D. Immediately after completion of the IV dose and 30 minutes before

Correct answer: B

Rationale: To accurately determine peak and trough levels of vancomycin, blood should be drawn two hours after the completion of the IV dose and 30 minutes before the next dose. This timing allows for appropriate assessment of the drug levels in the body, ensuring accurate monitoring of therapeutic and toxic concentrations. Choice A is incorrect as drawing blood midway through administration does not provide an accurate peak level. Choice C is incorrect as drawing blood one hour before the next dose does not represent the trough level. Choice D is incorrect because drawing blood immediately after completion of the IV dose does not allow enough time for the drug to reach peak levels.

5. A client with diabetes mellitus type 2 is prescribed metformin. What instruction should the nurse include in the client's teaching plan?

• A. Take this medication with meals.
• B. Avoid alcohol while taking this medication.
• C. Take this medication on an empty stomach.
• D. Report any signs of lactic acidosis to the healthcare provider.

Correct answer: A

Rationale: The correct instruction for a client prescribed metformin is to take the medication with meals. Taking metformin with meals helps to minimize gastrointestinal side effects, which are common with this medication. Choice B, avoiding alcohol, is a good practice due to the increased risk of lactic acidosis when alcohol is consumed with metformin; however, it is not the priority teaching point in this scenario. Taking metformin on an empty stomach (Choice C) is incorrect because it can increase the risk of gastrointestinal side effects. Reporting signs of lactic acidosis (Choice D) is important, but it is more related to monitoring for adverse effects rather than a primary teaching point for administration.

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