Nursing Elites

1. A client is prescribed metoprolol. The nurse should monitor for which common side effect of this medication?

• A. Dizziness
• B. Fatigue
• C. Orthostatic hypotension
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Dizziness. Metoprolol, a beta-blocker, can lead to dizziness as a common side effect due to its mechanism of action in reducing heart rate and blood pressure. This effect can cause a sensation of lightheadedness or unsteadiness, particularly when standing up quickly. While fatigue, orthostatic hypotension, and headache are potential side effects of metoprolol, dizziness is commonly observed and should be closely monitored by the nurse to ensure patient safety.

2. The healthcare provider notes that a client has a new prescription for 20 mEq of potassium. The IV site is inflamed but not tender, and has a blood flashback. What action should the healthcare provider take?

• A. Obtain a liter of normal saline with 20 mEq of KCl
• B. Contact the healthcare provider to clarify the prescription
• C. Withhold the prescription medication until a new IV is started
• D. Fax the prescription to the pharmacy for immediate dispensing

Correct answer: B

Rationale: The healthcare provider should contact the prescriber to clarify the prescription because an inflamed IV site may indicate potential issues with administering the medication. It is important to ensure that the prescription is appropriate and safe for the client before proceeding with administration. Option A is incorrect because administering potassium through an inflamed IV site can lead to further complications. Option C is not the best course of action as clarifying the prescription first is essential. Option D is also incorrect as the focus should be on ensuring the safety of the client before dispensing the medication.

3. A client with hypertension is prescribed lisinopril. The nurse should monitor the client for which potential side effect?

• A. Cough
• B. Dizziness
• C. Hyperkalemia
• D. Hyponatremia

Correct answer: A

Rationale: The correct answer is A: Cough. Lisinopril is known to cause a persistent dry cough as a side effect. It is essential for the nurse to monitor the client for this adverse reaction as it may lead to discontinuation of the medication. Dizziness, hyperkalemia, and hyponatremia are not typically associated with lisinopril use. Dizziness is more commonly seen with antihypertensives that cause orthostatic hypotension. Hyperkalemia and hyponatremia are not usually linked to lisinopril use.

4. A client receiving enalapril reports a persistent dry cough. The nurse should explain that this side effect is related to which medication action?

• A. It reduces the production of angiotensin II.
• B. It increases the production of angiotensin II.
• C. It causes increased production of bradykinin.
• D. It increases the production of aldosterone.

Correct answer: C

Rationale: The correct answer is C. Enalapril, an ACE inhibitor, inhibits the conversion of angiotensin I to angiotensin II, leading to increased levels of bradykinin. The accumulation of bradykinin is responsible for the persistent dry cough associated with ACE inhibitors like enalapril. Choices A, B, and D are incorrect because enalapril does not directly affect the production of angiotensin II or aldosterone. Instead, it primarily impacts the renin-angiotensin-aldosterone system by inhibiting the conversion of angiotensin I to angiotensin II, leading to bradykinin accumulation.

5. 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.

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