Nursing Elites

1. A client is taking Amiodarone to treat Atrial Fibrillation. Which of the following findings is a manifestation of Amiodarone toxicity?

• A. Light yellow urine
• B. Report of tinnitus
• C. Productive cough
• D. Blue-gray skin discoloration

Correct answer: D

Rationale: Blue-gray skin discoloration is a common sign of Amiodarone toxicity, known as blue-gray discoloration, which can affect areas like the face, neck, or hands. It is important to monitor for this side effect, as it can be a visible indicator of potential toxicity. Choices A, B, and C are incorrect. Light yellow urine is not typically associated with Amiodarone toxicity. Tinnitus is not a common manifestation of Amiodarone toxicity. A productive cough is not a recognized symptom of Amiodarone toxicity.

2. While caring for a client receiving epoetin alfa to treat anemia, which finding should the nurse monitor for?

• A. Leukocytosis
• B. Hypertension
• C. Hyperkalemia
• D. Fever

Correct answer: B

Rationale: The nurse should monitor the client for hypertension when receiving epoetin alfa. Epoetin alfa stimulates red blood cell production, which can lead to increased blood pressure. Leukocytosis (increased white blood cells) and hyperkalemia (high potassium levels) are not typically associated with epoetin alfa therapy. Fever is also not a common adverse effect of this medication.

3. A client is being discharged with a new prescription for an antihypertensive medication. Which of the following statements should the nurse provide?

• A. Be sure to limit your potassium intake while taking the medication.
• B. You should check your blood pressure every 8 hours while taking this medication.
• C. Your medication dosage will be increased if you develop tachycardia.
• D. Change positions slowly when you move from sitting to standing.

Correct answer: D

Rationale: The correct answer is D. Orthostatic hypotension is a common adverse effect of antihypertensive medications. The client should move slowly to a sitting or standing position and should be taught to sit or lie down if lightheadedness or dizziness occurs. Choices A, B, and C are incorrect. Limiting potassium intake is usually not necessary with antihypertensive medications. Checking blood pressure every 8 hours is not a standard recommendation unless specified by a healthcare provider. Increasing medication dosage due to tachycardia is not a typical practice for antihypertensive medications.

4. Which drug undergoes extensive first-pass hepatic metabolism?

• A. Heparin
• B. Insulin
• C. Propranolol
• D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

5. What finding should a nurse monitor for as an adverse effect when a client has a new prescription for Spironolactone?

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

Correct answer: A

Rationale: The correct answer is hyperkalemia. Spironolactone is a potassium-sparing diuretic that can lead to an increase in potassium levels. Hyperkalemia can be dangerous, causing muscle weakness and cardiac dysrhythmias. Monitoring potassium levels closely is crucial when a client is on Spironolactone. Hypoglycemia (choice B) is incorrect because Spironolactone does not typically affect blood glucose levels. Hypocalcemia (choice C) and hyponatremia (choice D) are also incorrect as Spironolactone's primary impact is on potassium levels.

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