Nursing Elites

1. A client in a long-term care facility has Hypothyroidism and a new prescription for Levothyroxine. Which of the following dosage schedules should the nurse expect for this client?

• A. The client will start at a high dose, and the dose will be tapered as needed.
• B. The client will remain on the initial dosage during the course of treatment.
• C. The client's dosage will be adjusted daily based on blood levels.
• D. The client will start on a low dose, which will be gradually increased.

Correct answer: D

Rationale: Levothyroxine should be initiated at a low dose and titrated gradually over several weeks to achieve therapeutic levels. This approach helps to minimize the risk of adverse effects, particularly in older adult clients who may be more sensitive to medication changes. Starting at a low dose allows for close monitoring of the client's response and adjustment of the dosage as needed to optimize treatment outcomes. Choice A is incorrect because starting at a high dose can increase the risk of adverse effects and is not the recommended approach. Choice B is incorrect because maintaining the initial dosage throughout the treatment may not achieve optimal therapeutic levels. Choice C is incorrect because adjusting the dosage daily based on blood levels is not the standard practice for initiating Levothyroxine treatment.

2. A healthcare provider is administering a Dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication?

• A. Lowered heart rate
• B. Increased myocardial contractility
• C. Decreased conduction through the AV node
• D. Vasoconstriction of renal blood vessels

Correct answer: B

Rationale: Dopamine, when administered at a low dose, acts on beta1 receptors in the heart, leading to increased myocardial contractility. This positive inotropic effect results in improved cardiac output, which is beneficial for a client with severe heart failure. Dopamine does not typically cause lowered heart rate, decreased conduction through the AV node, or vasoconstriction of renal blood vessels at low doses.

3. A client has a new prescription for Aspirin for the prevention of myocardial infarction. Which of the following findings should be identified as an adverse effect?

• A. Nausea
• B. Bruising
• C. Dizziness
• D. Dry mouth

Correct answer: B

Rationale: Bruising is an adverse effect to be monitored when a client is prescribed Aspirin for the prevention of myocardial infarction due to its association with increased bleeding risk. Aspirin's antiplatelet effect can lead to bruising and other signs of bleeding, necessitating close observation to prevent complications. Nausea, dizziness, and dry mouth are not typically recognized adverse effects of Aspirin therapy for myocardial infarction prevention.

4. A client is receiving warfarin therapy. Which of the following findings should the nurse identify as an adverse effect of warfarin?

• A. Nausea
• B. Epistaxis
• C. Diarrhea
• D. Dyspepsia

Correct answer: B

Rationale: Epistaxis, or nosebleeds, can be an indication of excessive anticoagulation while on warfarin therapy. Warfarin is a blood thinner that helps prevent blood clots. Epistaxis can occur as a result of the blood-thinning effects of warfarin, leading to increased bleeding tendencies, including nosebleeds. Nausea, diarrhea, and dyspepsia are not typically associated with warfarin therapy; therefore, they are not the adverse effects the nurse should identify in a client receiving warfarin.

5. A healthcare provider is providing teaching to a client who is starting therapy with paclitaxel. Which of the following adverse effects should the healthcare provider instruct the client to monitor?

• A. Bradycardia
• B. Diarrhea
• C. Neutropenia
• D. Urinary retention

Correct answer: C

Rationale: The correct answer is C: Neutropenia. Paclitaxel commonly causes neutropenia due to bone marrow suppression. It is essential for clients receiving this medication to monitor for signs of neutropenia, such as fever, chills, and increased susceptibility to infections, as it can increase the risk of serious complications.

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