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 with active tuberculosis asks why he must take four different medications. Which of the following responses should the nurse make?

• A. Taking four medications decreases the risk of a severe allergic reaction.
• B. Taking four medications reduces the chance that the bacteria will become resistant.
• C. Taking four medications reduces the risk of adverse reactions.
• D. Taking four medications decreases the chance of having a positive tuberculin skin test.

Correct answer: B

Rationale: When treating tuberculosis, using a combination of multiple medications is crucial to reduce the risk of bacterial resistance. The use of four medications helps to target the bacteria from different angles, making it harder for them to develop resistance to the treatment. This approach is essential to ensure the effectiveness of the treatment regimen and to prevent the spread of drug-resistant strains of tuberculosis. Choices A, C, and D are incorrect because the primary reason for using multiple medications in tuberculosis treatment is to prevent the development of bacterial resistance, not to decrease the risk of allergic reactions, adverse reactions, or affecting the tuberculin skin test results.

3. 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.

4. Which drug is the antidote for Alprazolam?

• A. Physostigmine
• B. Protamine sulfate
• C. Flumazenil
• D. Acetylcysteine

Correct answer: C

Rationale: Flumazenil is the specific antidote used to reverse the effects of Alprazolam. Alprazolam is a benzodiazepine, and Flumazenil is a benzodiazepine receptor antagonist that works by competitively inhibiting the actions of benzodiazepines at the receptor site, effectively reversing their sedative and other effects. Physostigmine is not used as an antidote for benzodiazepine overdose and can have significant side effects. Protamine sulfate is used to reverse the effects of heparin, not benzodiazepines like Alprazolam. Acetylcysteine is used as an antidote for acetaminophen overdose, not benzodiazepines like Alprazolam.

5. A healthcare professional is preparing to administer Enoxaparin to a client. Which of the following actions should the healthcare professional take?

• A. Administer the medication orally.
• B. Massage the injection site after administration.
• C. Insert the needle at a 45- to 90-degree angle.
• D. Aspirate before injecting the medication.

Correct answer: C

Rationale: Enoxaparin should be administered subcutaneously at a 45- to 90-degree angle. This angle ensures proper delivery of the medication. Massaging the injection site should be avoided to prevent bruising and possible tissue damage. Aspiration is not required for subcutaneous injections like Enoxaparin. Therefore, the correct action for administering Enoxaparin is to insert the needle at a 45- to 90-degree angle.

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