Nursing Elites

1. A client with type 2 diabetes is prescribed metformin. What instruction should the practical nurse (PN) include in the client's teaching plan?

• A. Take the medication with meals to decrease gastrointestinal upset.
• B. Take the medication with a full glass of water.
• C. Avoid alcohol while taking the medication.
• D. Take the medication with meals to increase absorption.

Correct answer: B

Rationale: The correct instruction for a client prescribed metformin is to take the medication with a full glass of water. This helps ensure proper ingestion and absorption of the medication. While taking metformin with meals can help reduce gastrointestinal side effects, the primary focus should be on adequate hydration and absorption by taking it with water. Avoiding alcohol while taking metformin is also important as alcohol can increase the risk of lactic acidosis when combined with metformin. Taking the medication with meals to increase absorption is incorrect as metformin should be taken with food to reduce gastrointestinal upset, not to increase absorption.

2. A client with pulmonary tuberculosis has been taking rifampin for 3 weeks. The client reports orange urine. What should be the nurse's next action?

• A. Notify the client's health care provider.
• B. Inform the client that this is not harmful.
• C. Assess the client for other signs of nephrotoxicity.
• D. Monitor the client's most recent creatinine level.

Correct answer: B

Rationale: The correct action for the nurse to take when a client reports orange urine after taking rifampin is to inform the client that this change is not harmful. Rifampin is known to cause orange discoloration of urine, which is a harmless side effect. There is no need to notify the health care provider as this is an expected outcome. Monitoring creatinine levels or assessing for nephrotoxicity is unnecessary in this situation, as rifampin does not typically cause kidney damage.

3. A client admitted with shortness of breath and palpitations currently takes an antiarrhythmic medication, dronedarone. Which action should the nurse take to prevent arrhythmias?

• A. Measure orthostatic blood pressure
• B. Obtain a 12-lead ECG reading daily
• C. Assess the client's apical pulse daily
• D. Provide continuous ECG monitoring

Correct answer: D

Rationale: The correct action to prevent arrhythmias in a client taking an antiarrhythmic medication like dronedarone is to provide continuous ECG monitoring. This is essential because antiarrhythmic drugs can sometimes cause pro-arrhythmic effects, which may lead to dangerous heart rhythm disturbances. Continuous ECG monitoring allows for real-time detection of any abnormal rhythms, enabling prompt intervention. Measuring orthostatic blood pressure, obtaining a 12-lead ECG reading daily, and assessing the client's apical pulse daily are important assessments in general patient care but may not specifically prevent arrhythmias in this scenario.

4. A client with a diagnosis of bipolar disorder is prescribed carbamazepine. The nurse should monitor for which potential adverse effect?

• A. Agranulocytosis
• B. Hair loss
• C. Liver toxicity
• D. Weight gain

Correct answer: A

Rationale: Carbamazepine is associated with the potential adverse effect of agranulocytosis, a serious condition characterized by a low white blood cell count. Monitoring white blood cell counts regularly is crucial to detect this adverse effect early and prevent complications.

5. A client with a history of atrial fibrillation is prescribed diltiazem. The nurse should monitor for which potential side effect?

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

Correct answer: A

Rationale: The correct answer is A: Hypotension. Diltiazem is a calcium channel blocker that can cause hypotension by relaxing blood vessels and reducing blood pressure. Monitoring blood pressure is essential to detect and manage this potential side effect. Choices B, C, and D are incorrect because diltiazem typically does not cause tachycardia, headache, or hyperglycemia as common side effects.

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