Nursing Elites

1. A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus was previously well controlled with daily glyburide (DiaBeta). However, the fasting blood glucose level has recently been in the range of 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Prednisone
• B. Phenelzine (Nardil)
• C. Atenolol (Tenormin)
• D. Allopurinol (Zyloprim)

Correct answer: A

Rationale: Prednisone is known to reduce the effectiveness of oral hypoglycemic medications like glyburide and insulin, which can result in hyperglycemia. Therefore, the addition of prednisone to the client's regimen could have contributed to the elevated fasting blood glucose levels observed.

2. Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A healthcare provider reinforces instructions for the client and advises them to avoid which of the following while taking this medication?

• A. Alcohol
• B. Organ meats
• C. Whole-grain cereals
• D. Carbonated beverages

Correct answer: A

Rationale: Alcohol should be avoided when taking glimepiride (Amaryl) because it can cause a disulfiram-like reaction and enhance the hypoglycemic effects of the medication. Consuming alcohol with glimepiride can lead to symptoms such as flushing, palpitations, nausea, and vomiting. Therefore, it is crucial for individuals on glimepiride therapy to steer clear of alcohol to prevent adverse reactions and maintain optimal medication efficacy.

3. Which statement by the client indicates a need for further teaching about the use of metoprolol (Lopressor)?

• A. I will not stop taking the medication abruptly.
• B. I will take my pulse before taking the medication.
• C. I will take the medication with food.
• D. I will take the medication at bedtime.

Correct answer: D

Rationale: The correct answer is D because taking metoprolol (Lopressor) at bedtime is not specifically recommended. Metoprolol should be taken with food to enhance absorption. It is crucial for the client not to stop taking the medication abruptly to prevent rebound hypertension or other adverse effects. Additionally, monitoring the pulse before taking metoprolol is important for assessing its effect on heart rate.

4. Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication?

• A. To take the medication after meals
• B. To return to the clinic weekly for serum drug-level testing
• C. To call the health care provider (HCP) if a skin rash occurs
• D. To restrict alcohol intake with this medication

Correct answer: B

Rationale: Cycloserine requires weekly serum drug level determinations to monitor for neurotoxicity. The medication must be taken after meals, and the client should avoid alcohol. Additionally, the client should report any signs of skin rash or central nervous system toxicity to the healthcare provider.

5. After the initial dose, which of the following is the priority assessment for a client being treated for acute congestive heart failure with intravenously administered bumetanide?

• A. Monitoring weight loss
• B. Monitoring temperature
• C. Monitoring blood pressure
• D. Monitoring potassium level

Correct answer: C

Rationale: The correct answer is monitoring blood pressure. Bumetanide is a loop diuretic, and monitoring blood pressure is crucial as hypotension is a common side effect. Hypotension can further worsen the condition of a patient with congestive heart failure, so assessing and managing blood pressure is a priority after administering bumetanide.

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