Nursing Elites

1. A patient on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?

• A. Reduced cardiac function
• B. First-pass effect
• C. Reduced hepatic function
• D. Increased gastric motility

Correct answer: C

Rationale: In older adults, reduced hepatic function can lead to prolonged effects of medications metabolized by the liver. This prolonged effect may result in drowsiness the next morning. Adjusting the dosage of the hypnotic medication may be necessary for this client. Choices A, B, and D are incorrect. Reduced cardiac function (Choice A) is not typically associated with drowsiness due to medication effects. The first-pass effect (Choice B) relates to the initial metabolism of a drug in the liver before reaching systemic circulation, which is not directly linked to drowsiness the next morning. Increased gastric motility (Choice D) does not commonly cause drowsiness as described in the scenario.

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

• A. Tachycardia
• B. Hypoglycemia
• C. Bradycardia
• D. Hypertension

Correct answer: C

Rationale: Atenolol is a beta-blocker that can cause bradycardia as an adverse effect due to its mechanism of action in slowing down the heart rate. The nurse should instruct the client to monitor their pulse regularly and report any significant decreases to prevent complications related to bradycardia.

3. A client has a new prescription for Etanercept for Rheumatoid Arthritis. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will need to get my blood drawn periodically while on this medication.
• B. I should stop taking this medication if I develop a rash.
• C. I will need to limit my alcohol intake to no more than one drink per week.
• D. I should self-administer this medication subcutaneously.

Correct answer: A

Rationale: The correct answer is A because Etanercept can cause bone marrow suppression, so it is crucial to monitor blood counts regularly to detect any early signs of adverse effects.

4. A client has a new prescription for Ondansetron for nausea and vomiting associated with chemotherapy. Which of the following statements should the nurse include?

• A. Take this medication one hour before chemotherapy.
• B. You may experience a headache while taking this medication.
• C. Increase your intake of potassium while taking this medication.
• D. This medication may cause temporary hearing loss.

Correct answer: B

Rationale: The correct statement the nurse should include is that the client may experience a headache while taking Ondansetron. Headache is a common side effect of this medication, and clients need to be informed about this potential adverse reaction to enhance their understanding and management of side effects. The other statements are incorrect because Ondansetron is usually taken 30 minutes before chemotherapy, not one hour before (choice A). There is no specific need to increase potassium intake while taking Ondansetron (choice C), and temporary hearing loss is not a common side effect associated with this medication (choice D).

5. A client in the post-anesthesia recovery unit received a nondepolarizing neuromuscular blocking agent and is experiencing muscle weakness. The nurse should anticipate a prescription for which of the following medications?

• A. Neostigmine
• B. Naloxone
• C. Dantrolene
• D. Vecuronium

Correct answer: A

Rationale: Neostigmine is a cholinesterase inhibitor commonly used to reverse the effects of nondepolarizing neuromuscular blockers by increasing acetylcholine levels at the neuromuscular junction, thereby helping to restore muscle strength. Naloxone is an opioid antagonist used to reverse opioid effects, not neuromuscular blockade. Dantrolene is a skeletal muscle relaxant used to treat malignant hyperthermia or neuroleptic malignant syndrome, not to reverse neuromuscular blockade. Vecuronium is a nondepolarizing neuromuscular blocking agent, like the one the client received, and is not used to reverse its effects.

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