Nursing Elites

1. A healthcare provider is assessing a client who is taking levothyroxine. The healthcare provider should recognize that which of the following findings is a manifestation of levothyroxine overdose?

• A. Insomnia
• B. Constipation
• C. Drowsiness
• D. Hypoactive deep-tendon reflexes

Correct answer: A

Rationale: Insomnia is a common symptom of levothyroxine overdose due to excessive stimulation of the central nervous system. Levothyroxine is a thyroid hormone replacement medication, and an overdose can lead to hyperthyroidism symptoms, including insomnia. Constipation and drowsiness are not typically associated with levothyroxine overdose. Hypoactive deep-tendon reflexes are more indicative of hypothyroidism rather than an overdose of levothyroxine.

2. Phenytoin is an antiarrhythmic and anticonvulsant that has an unlabeled use for:

• A. Headaches
• B. Cold remedy
• C. Neuropathic pain
• D. Antianxiety

Correct answer: C

Rationale: Phenytoin, an antiarrhythmic and anticonvulsant medication, is also used off-label for treating neuropathic pain. While its primary indications are for managing heart rhythm disorders and seizures, it has shown efficacy in managing neuropathic pain, expanding its clinical utility. Choices A, B, and D are incorrect as phenytoin is not commonly used for headaches, cold remedies, or antianxiety purposes.

3. A client with Hodgkin's disease is receiving Cyclophosphamide IV. Which medication should be administered concurrently to prevent an adverse effect of Cyclophosphamide?

• A. Uroprotectant agent, such as mesna
• B. Opioid, such as morphine
• C. Loop diuretic, such as furosemide
• D. H1 receptor antagonist, such as diphenhydramine

Correct answer: A

Rationale: Mesna, an uroprotectant agent, is administered with nitrogen mustard chemotherapy drugs like Cyclophosphamide to prevent hemorrhagic cystitis, a common adverse effect. Mesna works by binding to and inactivating the toxic metabolites of Cyclophosphamide in the bladder, thereby reducing the risk of bladder toxicity.

4. A client has a new prescription for Labetalol. Which of the following instructions should be provided?

• A. Take the medication with food.
• B. Monitor your blood glucose levels.
• C. Expect a rapid heart rate.
• D. Increase your intake of high-sodium foods.

Correct answer: A

Rationale: The correct answer is A: Take the medication with food. Labetalol should be taken with food to increase absorption and reduce the risk of orthostatic hypotension. Taking it with food helps in better absorption and minimizes the potential drop in blood pressure when standing up, which can occur with this medication. Choice B is incorrect as Labetalol is not primarily associated with affecting blood glucose levels. Choice C is incorrect as Labetalol is a beta-blocker that would actually lower heart rate, not increase it. Choice D is incorrect because increasing intake of high-sodium foods could counteract the antihypertensive effects of Labetalol.

5. A client has a new prescription for metronidazole. The client should avoid which of the following?

• A. Dairy products
• B. Alcohol
• C. Leafy green vegetables
• D. Grapefruit juice

Correct answer: B

Rationale: The correct answer is B: Alcohol. Clients should avoid alcohol while taking metronidazole to prevent a disulfiram-like reaction, which can cause symptoms such as nausea, vomiting, headache, and flushing. Alcohol can interact with metronidazole and lead to adverse effects. Choices A, C, and D are not typically contraindicated with metronidazole. Dairy products, leafy green vegetables, and grapefruit juice do not have significant interactions with metronidazole, unlike alcohol.

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