Nursing Elites

1. The client has been taking divalproex (Depakote) for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test?

• A. Alanine aminotransferase (ALT)
• B. Serum glucose
• C. Serum creatinine
• D. Serum electrolytes

Correct answer: A

Rationale: The correct answer is Alanine aminotransferase (ALT). Monitoring ALT levels is crucial when a patient is taking divalproex (Depakote) due to the risk of drug-induced hepatitis. Elevated ALT levels indicate liver damage or disorders, which can be a side effect of Depakote. Serum glucose (choice B) is not the priority for monitoring in this case, as the medication does not directly affect glucose levels. Serum creatinine (choice C) is not the most relevant test to monitor for Depakote use; it primarily assesses kidney function. Serum electrolytes (choice D) are important but do not take precedence over monitoring ALT levels when a patient is on Depakote.

2. A client is being taught about self-administration of Haldol 15 mg po hs. For which side effect/s should the client seek medical attention?

• A. Shortness of breath and fatigue
• B. Restlessness and muscle spasms
• C. Dry mouth
• D. Diarrhea

Correct answer: B

Rationale: The correct answer is restlessness and muscle spasms. Haldol, an antipsychotic medication, can cause extrapyramidal side effects such as muscle spasms and restlessness. These side effects can be serious and should prompt the client to seek medical attention. Shortness of breath, fatigue, dry mouth, and diarrhea are not commonly associated with Haldol use, making choices A, C, and D incorrect.

3. A patient has recently been prescribed Zidovudine (Retrovir). The patient has AIDS. Which of the following side effects should the patient specifically watch out for?

• A. Weakness and SOB
• B. Fever and anemia
• C. Hypertension and SOB
• D. Fever and hypertension

Correct answer: B

Rationale: The correct answer is 'Fever and anemia.' Zidovudine (Retrovir) is known to cause anemia as a side effect due to its impact on the bone marrow. Fever is also a common side effect associated with Zidovudine use. Therefore, the patient should watch out for these specific side effects. Choice A (Weakness and SOB) is incorrect as shortness of breath (SOB) is not a commonly reported side effect of Zidovudine. Choice C (Hypertension and SOB) and Choice D (Fever and hypertension) are unrelated to the known side effects of Zidovudine, making them incorrect.

4. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a maintenance dose.
• B. a loading dose.
• C. a medication with no first-pass effect.
• D. the medication to be given intravenously.

Correct answer: B

Rationale: To rapidly achieve a therapeutic plasma drug concentration, a loading or priming dose is ordered. This dose quickly establishes the desired drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose, like choice A, is used to maintain the therapeutic level after the loading dose. Waiting for steady state without a loading dose would take five drug half-lives. Choice C, a medication with no first-pass effect, does not directly address the need for rapid attainment of therapeutic levels. While intravenous administration (choice D) offers excellent bioavailability, a single dose by this route may not achieve the desired therapeutic plasma concentration as rapidly as a loading dose.

5. The client is admitted with a period of unobserved loss of consciousness and now has an EEG scheduled this morning. What should the nurse implement?

• A. Keep NPO and hold medication.
• B. Hold sedatives, but allow the client to have breakfast and give other medicines.
• C. Administer medications, but hold anticonvulsants.
• D. Give additional fluids and some caffeine prior to the test.

Correct answer: C

Rationale: Prior to an EEG, it is essential for the client to eat to prevent a drop in blood sugar levels. The nurse should hold sedatives but allow the client to have breakfast and administer other necessary medications. Holding sedatives is crucial to ensure accurate EEG results, while providing breakfast helps maintain stable blood sugar levels. Administering other medications, excluding sedatives, is important for the client's overall care. Choices A, C, and D are incorrect because keeping the client NPO and holding medications, administering medications but holding anticonvulsants, and giving additional fluids and caffeine are not appropriate actions before an EEG.

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