Nursing Elites

1. A client is starting therapy with bicalutamide. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Muscle pain
• B. Flushing
• C. Gynecomastia
• D. Hyperglycemia

Correct answer: C

Rationale: The correct answer is gynecomastia (Choice C). Bicalutamide is associated with gynecomastia due to its antiandrogenic properties. Gynecomastia, the development of breast tissue in males, is an important adverse effect to monitor when taking bicalutamide. Choices A, B, and D are incorrect. Muscle pain and flushing are not commonly associated with bicalutamide use. Hyperglycemia is not a typical adverse effect of bicalutamide therapy.

2. A healthcare professional is preparing to administer a dose of Hydromorphone IV to a client. Which of the following actions should the healthcare professional take?

• A. Administer the medication over 5 minutes.
• B. Administer a dose of Naloxone prior to giving the Hydromorphone.
• C. Assess the client's blood pressure prior to administration.
• D. Inject the medication into the client's subcutaneous tissue.

Correct answer: A

Rationale: The correct action for the healthcare professional preparing to administer IV Hydromorphone to a client is to administer the medication over 5 minutes. This slow administration is crucial to reduce the risk of hypotension and respiratory depression. Administering the medication rapidly can lead to adverse effects. Option B, administering Naloxone prior to Hydromorphone, is incorrect because Naloxone is used as an antidote for opioid overdose, not as a routine pre-medication. Option C, assessing the client's blood pressure before administration, is important but not the immediate action to take to reduce adverse effects of Hydromorphone. Option D, injecting the medication into the client's subcutaneous tissue, is incorrect as Hydromorphone is meant for intravenous administration for rapid onset of action.

3. A client has a new prescription for Warfarin. Which of the following instructions should the nurse include?

• A. Avoid consuming foods high in vitamin K.
• B. Monitor your blood pressure regularly.
• C. Increase your intake of green, leafy vegetables.
• D. Take the medication with a high-fat meal.

Correct answer: A

Rationale: The correct answer is to advise the client to avoid consuming foods high in vitamin K. Warfarin's effectiveness can be affected by vitamin K intake. Clients should maintain a consistent intake of vitamin K and avoid sudden increases in foods high in vitamin K to ensure the medication works properly and consistently. Choices B, C, and D are incorrect. Monitoring blood pressure, increasing intake of green, leafy vegetables, or taking the medication with a high-fat meal are not specific instructions related to Warfarin therapy.

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. When a client is discharged with nitroglycerin (Nitrostat), what should the nurse include in client education?

• A. “Your chest pain should go away with one tablet.”
• B. “If your chest pain doesn’t go away after three tablets, call 911; you might be having a heart attack.”
• C. “If your chest pain doesn’t go away with one tablet, you can repeat the dose as many times as you need to.”
• D. “Be sure to call 911 before you take any tablets.”

Correct answer: B

Rationale: The correct answer instructs the client on the appropriate use of nitroglycerin. Nitroglycerin is used to relieve chest pain or angina. If the chest pain does not subside after taking one tablet, the client should take a maximum of three tablets at 5-minute intervals. If the pain persists after three tablets, it could indicate a heart attack, and emergency medical help should be sought. This education is crucial to ensure the client knows when to seek immediate medical attention.

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