Nursing Elites

1. A client with type 2 diabetes mellitus is prescribed dulaglutide. The nurse should monitor for which potential adverse effect?

• A. Nausea
• B. Hypoglycemia
• C. Hyperglycemia
• D. Pancreatitis

Correct answer: A

Rationale: The correct answer is 'Nausea.' Dulaglutide, a medication commonly used in the management of type 2 diabetes, can lead to gastrointestinal side effects such as nausea. While hypoglycemia and hyperglycemia are potential concerns in diabetes management, they are not typically associated with dulaglutide use. Pancreatitis is a serious adverse effect of some diabetes medications, but it is not a common side effect of dulaglutide.

2. A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines the client has been self-administering St. John's wort, an herbal preparation, on the advice of a friend. What information is most significant about this finding?

• A. Wort can decrease plasma concentration of Cyclospora
• B. Wort can decrease plasma concentration of Tacrolimus
• C. Wort can decrease plasma concentration of Cyclosporine
• D. Wort can decrease plasma concentration of Mycophenolate

Correct answer: C

Rationale: The most significant information about the client self-administering St. John's wort, an herbal preparation, is that it can decrease the plasma concentration of Cyclosporine. St. John's wort is known to reduce the efficacy of Cyclosporine, which is a common immunosuppressant drug used to prevent transplant rejection. Choices A, B, and D are incorrect because St. John's wort does not affect the plasma concentration of Cyclospora, Tacrolimus, or Mycophenolate.

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

• A. Dry mouth
• B. Weight gain
• C. Headache
• D. Dizziness

Correct answer: C

Rationale: The correct answer is C: Headache. Dabigatran, an anticoagulant, can cause headache as a potential side effect. Headache is important to monitor as it may indicate adverse effects or complications that need attention. Choices A, B, and D are incorrect because dry mouth, weight gain, and dizziness are not commonly associated with dabigatran use.

4. A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigued and dizzy. Which instruction should the nurse provide?

• A. Avoid hazardous activities until symptoms subside
• B. Contact the healthcare provider immediately
• C. Continue taking the medication every day
• D. Stop taking the medication until the unpleasant side effects wear off

Correct answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to avoid hazardous activities until the symptoms of fatigue and dizziness subside. These side effects can impair the client's ability to engage in activities that require alertness and coordination, posing a risk for accidents. Contacting the healthcare provider immediately may not be necessary unless the symptoms worsen or persist. Continuing to take the medication every day without addressing the side effects can lead to further complications. Stopping the medication abruptly without healthcare provider guidance can also be risky and may not be necessary if the symptoms improve with time.

5. In the emergency department, a child is admitted for accidental ingestion of a poison. The practical nurse (PN) should know that inducing vomiting is recommended for which child?

• A. An 8-month-old who ingested four to six ibuprofen tablets
• B. A 3-year-old who drank an unknown amount of charcoal lighter fluid
• C. A 16-month-old who ingested 2 ounces of acetaminophen elixir
• D. A 2-year-old who ate a handful of automatic dishwasher detergent

Correct answer: C

Rationale: Inducing emesis is recommended for the child who ingested a large dose of acetaminophen elixir because this medication is hepatotoxic. Acetaminophen overdose can lead to severe liver damage, and prompt removal from the stomach can help reduce absorption and potential harm.

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