Nursing Elites

1. A client is receiving meperidine (Demerol) for pain management. Which assessment finding requires immediate action?

• A. Constipation
• B. Drowsiness
• C. Respiratory rate of 10 breaths per minute
• D. Nausea

Correct answer: C

Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a severe side effect of meperidine (Demerol) that necessitates immediate intervention to prevent further complications. Constipation, drowsiness, and nausea are common but less urgent side effects that do not pose an immediate life-threatening risk. Respiratory depression can lead to respiratory arrest and must be addressed promptly to ensure the client's safety and well-being.

2. Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin:

• A. 1 hour after each meal
• B. Once daily, at the same time each day
• C. 15 minutes before breakfast, lunch, and dinner
• D. Before each meal, based on the blood glucose level

Correct answer: B

Rationale: Insulin glargine (Lantus) is a long-acting insulin with a duration of action of approximately 24 hours, making it suitable for once-daily dosing at the same time each day. This regimen helps maintain consistent blood glucose levels and simplifies the client's treatment routine. Taking insulin glargine once daily provides basal insulin coverage throughout the day, reducing the risk of hypoglycemia compared to short-acting insulins that are taken before each meal.

3. Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?

• A. Discontinuation of warfarin sodium (Coumadin)
• B. A decrease in the warfarin sodium (Coumadin) dosage
• C. An increase in the warfarin sodium (Coumadin) dosage
• D. A decrease in the usual dose of nalidixic acid (NegGram)

Correct answer: B

Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma proteins. When an oral anticoagulant, like warfarin sodium (Coumadin), is combined with nalidixic acid, a decrease in the anticoagulant dosage may be necessary to avoid excessive anticoagulation and potential bleeding risks. Therefore, the correct action for the nurse to anticipate in this situation is a decrease in the warfarin sodium (Coumadin) dosage. Choice A is incorrect because discontinuing warfarin sodium abruptly can lead to thrombosis or embolism. Choice C is incorrect as increasing the warfarin sodium dosage can potentiate the anticoagulant effect, leading to bleeding complications. Choice D is incorrect as reducing the dose of nalidixic acid would not directly address the interaction with warfarin sodium.

4. A client is receiving desmopressin acetate (DDAVP), and a healthcare provider is monitoring for adverse effects. Which of the following indicates the presence of an adverse effect?

• A. Insomnia
• B. Drowsiness
• C. Weight loss
• D. Increased urination

Correct answer: B

Rationale: Drowsiness can be a sign of water intoxication or hyponatremia, which are potential adverse effects of desmopressin acetate (DDAVP). It is crucial to monitor for this symptom and promptly address it to prevent complications.

5. A client presenting with complaints of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension, including a beta-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?

• A. Dyspnea, edema, and palpitations
• B. Chest pain, hypotension, and paresthesia
• C. Double vision, loss of appetite, and nausea
• D. Constipation, dry mouth, and sleep disorder

Correct answer: C

Rationale: The correct answer is C. Double vision, loss of appetite, and nausea are classic signs of digoxin toxicity. Other signs may include bradycardia, visual disturbances, and confusion. These symptoms are indicators that the client may be experiencing adverse effects due to elevated levels of digoxin in the system, requiring immediate medical attention to prevent serious complications.

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