Nursing Elites

1. A client with rheumatoid arthritis is prescribed methotrexate. The nurse should include which instruction in the client's teaching plan?

• A. Avoid alcohol while taking this medication.
• B. Take this medication with food to decrease gastrointestinal upset.
• C. Avoid sunlight while taking this medication.
• D. Report any signs of infection to the healthcare provider.

Correct answer: C

Rationale: The correct instruction for a client prescribed methotrexate is to avoid sunlight while taking this medication. Methotrexate can increase sensitivity to sunlight, leading to skin reactions. It is essential for clients to limit sun exposure and use protective measures like sunscreen and clothing coverage to prevent adverse effects. Choices A, B, and D are incorrect because avoiding alcohol, taking with food, and reporting signs of infection are not specific instructions related to methotrexate therapy.

2. A client with a diagnosis of schizophrenia is prescribed clozapine. The nurse should monitor the client for which potential side effect?

• A. Agranulocytosis
• B. Dry mouth
• C. Weight gain
• D. Hypersalivation

Correct answer: A

Rationale: The correct answer is Agranulocytosis. Clozapine is known to potentially cause agranulocytosis, a serious condition characterized by a dangerously low white blood cell count. Monitoring white blood cell counts is crucial to detect this side effect early and prevent complications. Choices B, C, and D are incorrect because dry mouth, weight gain, and hypersalivation are not typically associated with clozapine use. While dry mouth can be a common side effect of some antipsychotic medications, it is not specifically linked to clozapine. Weight gain can occur with certain antipsychotics, but clozapine is more commonly associated with metabolic side effects. Hypersalivation is not a common side effect of clozapine.

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

• A. Hypotension
• B. Tachycardia
• C. Hyperglycemia
• D. Hyponatremia

Correct answer: A

Rationale: The correct answer is A: Hypotension. Valsartan is an angiotensin II receptor blocker that can cause hypotension as a side effect by dilating blood vessels. Monitoring blood pressure is crucial to prevent complications related to low blood pressure. Choice B, Tachycardia, is incorrect because valsartan typically does not cause an increase in heart rate. Choice C, Hyperglycemia, is not a common side effect of valsartan. Choice D, Hyponatremia, is also unlikely with valsartan use.

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. How should the healthcare provider schedule the administering of propylthiouracil (PTU)?

• A. Offer both drugs together with a meal
• B. Give parental dose once every 24 hours
• C. Schedule both medications at bedtime
• D. Administer iodine one hour before PTU

Correct answer: D

Rationale: Administering iodine one hour before PTU is crucial to ensure proper absorption and effectiveness of PTU. This timing helps optimize the therapeutic benefits of PTU by allowing it to be absorbed efficiently without interference from iodine, ultimately leading to better treatment outcomes for the patient. Choices A, B, and C are incorrect because offering both drugs together with a meal, giving parental dose once every 24 hours, and scheduling both medications at bedtime do not address the specific timing requirement of administering iodine before PTU for optimal absorption.

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