Nursing Elites

1. A client with chronic Neutropenia is receiving Filgrastim. What action should the nurse take to assess for an adverse effect of filgrastim?

• A. Assess for bone pain.
• B. Assess for right lower quadrant pain.
• C. Auscultate for crackles in the bases of the lungs.
• D. Auscultate the chest to listen for a heart murmur.

Correct answer: A

Rationale: Bone pain is a known adverse effect of Filgrastim, which is dose-related. By assessing for bone pain, the nurse can monitor for this common side effect. Acetaminophen and, if necessary, an opioid analgesic can be used to manage the bone pain associated with Filgrastim. Assessing for right lower quadrant pain, crackles in the bases of the lungs, or heart murmurs would not directly relate to the adverse effects of Filgrastim in a client with chronic Neutropenia.

2. A client has a new prescription for Spironolactone. Which of the following findings should the nurse monitor as an adverse effect?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

Correct answer: A

Rationale: Corrected Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as an adverse effect. Hyperkalemia can result in muscle weakness and cardiac dysrhythmias, making it essential for the nurse to monitor potassium levels closely when a client is on Spironolactone. Choice B, Hypoglycemia, is incorrect because Spironolactone is not known to cause low blood sugar levels. Choice C, Hypocalcemia, and Choice D, Hyponatremia, are also incorrect as Spironolactone is not associated with decreased levels of calcium or sodium.

3. A client with Diabetes is experiencing Nausea due to Gastroparesis. The healthcare provider should anticipate a prescription for which of the following medications?

• A. Lubiprostone
• B. Metoclopramide
• C. Bisacodyl
• D. Loperamide

Correct answer: B

Rationale: Metoclopramide, a dopamine antagonist, is indicated for treating nausea and increasing gastric motility. In the context of diabetic gastroparesis, it can alleviate bloating and nausea by enhancing gastric emptying. Lubiprostone (Choice A) is a chloride channel activator used for chronic idiopathic constipation and irritable bowel syndrome with constipation. Bisacodyl (Choice C) is a stimulant laxative primarily used for constipation. Loperamide (Choice D) is an anti-diarrheal agent and would not be appropriate for treating nausea and gastroparesis.

4. What should you monitor when administering Clopidogrel to a patient?

• A. Signs of thrombotic thrombocytopenic purpura
• B. Bleeding during therapy
• C. CBC with differential and platelet count
• D. All of the above

Correct answer: D

Rationale: When administering Clopidogrel, it is crucial to monitor for signs of thrombotic thrombocytopenic purpura, bleeding during therapy, and changes in CBC with differential and platelet count. Thrombotic thrombocytopenic purpura is a rare but serious condition associated with Clopidogrel use, characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and renal dysfunction. Monitoring for signs of thrombotic thrombocytopenic purpura is essential to detect this potentially life-threatening condition early. Monitoring for bleeding helps to assess the risk of hemorrhagic events, a known side effect of Clopidogrel. Additionally, regular monitoring of CBC with differential and platelet count is necessary to evaluate the drug's impact on blood cell counts and detect any abnormalities that may require intervention. Therefore, monitoring all these parameters is vital to ensure patient safety and appropriate management during Clopidogrel therapy.

5. A client is starting therapy with docetaxel. Which of the following findings should the nurse instruct the client to report?

• A. Flushing
• B. Dyspnea
• C. Hyperglycemia
• D. Tinnitus

Correct answer: B

Rationale: The correct answer is B: Dyspnea. The nurse should instruct the client to report dyspnea because it can indicate pulmonary toxicity, a severe adverse effect of docetaxel. Dyspnea may suggest a potential serious condition that needs prompt evaluation and intervention to prevent complications. Flushing (choice A) is more commonly associated with other medications or conditions and is not a common side effect of docetaxel. Hyperglycemia (choice C) and tinnitus (choice D) are also not typically associated with docetaxel therapy and are not priority findings that the nurse should instruct the client to report.

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