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 a course of Metronidazole to treat an infection. For which of the following adverse effects should the client stop taking Metronidazole and notify the provider?

• A. Metallic taste
• B. Nausea
• C. Ataxia
• D. Dark-colored urine

Correct answer: C

Rationale: The correct answer is C, 'Ataxia.' Ataxia is a sign of central nervous system (CNS) toxicity, which can be a severe adverse effect of Metronidazole. Metallic taste and nausea are common side effects of Metronidazole but do not require stopping the medication unless they persist or worsen. Dark-colored urine is not typically associated with Metronidazole and does not indicate a severe adverse effect.

3. A client is taking Ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this medication?

• A. Increased TSH level
• B. Decreased ALT level
• C. Hypoglycemia
• D. Hyperlipidemia

Correct answer: D

Rationale: The correct answer is D: Hyperlipidemia. Ritonavir, a protease inhibitor used in HIV treatment, can lead to hyperlipidemia, characterized by increased cholesterol and triglyceride levels. Monitoring lipid levels is crucial to identify and manage this potential adverse effect. Choices A, B, and C are incorrect because Ritonavir is not known to cause an increased TSH level, decreased ALT level, or hypoglycemia as adverse effects.

4. A client with Bipolar disorder has a new prescription for Carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

• A. This medication can safely be taken during pregnancy.
• B. Eliminate grapefruit juice from your diet.
• C. You will need to have a complete blood count and carbamazepine levels drawn periodically.
• D. Notify your provider if you develop a rash.

Correct answer: B

Rationale: The correct answer is B: "Eliminate grapefruit juice from your diet." Grapefruit juice affects carbamazepine metabolism and should be avoided. It can lead to increased levels of the medication, potentially causing toxicity. Monitoring carbamazepine blood levels and the complete blood count (CBC) is essential to ensure the medication's efficacy and safety. Although choice A is incorrect (This medication can safely be taken during pregnancy), carbamazepine is classified as a Pregnancy Category D drug, which means there is positive evidence of human fetal risk. Choice D (Notify your provider if you develop a rash) is also important because carbamazepine can cause serious adverse effects like Stevens-Johnson syndrome, which can be life-threatening. Regular monitoring and prompt reporting of any rash are crucial. Therefore, choices C and D are also relevant instructions for the client.

5. A healthcare provider is providing discharge instructions to a client who is prescribed Enalapril. Which of the following adverse effects should the healthcare provider instruct the client to monitor?

• A. Dry cough
• B. Weight gain
• C. Diarrhea
• D. Nausea

Correct answer: A

Rationale: A persistent dry cough is a common adverse effect of Enalapril, an ACE inhibitor. This cough is a result of increased bradykinin levels due to ACE inhibition. The client should be educated to monitor for a dry cough and notify the healthcare provider if it occurs, as it may indicate the need for a medication adjustment. Choices B, C, and D are incorrect because weight gain, diarrhea, and nausea are not commonly associated adverse effects of Enalapril.

Similar Questions