Nursing Elites

1. A client is starting therapy with Metformin. Which of the following instructions should the nurse include?

• A. Take this medication with your first bite of food.
• B. Take this medication on an empty stomach.
• C. Take this medication before bedtime.
• D. Take this medication every other day.

Correct answer: A

Rationale: Metformin should be taken with meals to reduce gastrointestinal side effects and ensure better absorption. Instructing the client to take the medication with the first bite of food helps in achieving optimal effectiveness and minimizes the risk of side effects like nausea or upset stomach. Choice B is incorrect because taking Metformin on an empty stomach can lead to increased gastrointestinal side effects. Choice C is incorrect as there is no specific timing requirement for taking Metformin before bedtime. Choice D is incorrect as Metformin is usually taken daily, not every other day.

2. How do ACE inhibitors work?

• A. Block the vasoconstrictor and aldosterone effects of angiotensin II at the receptor site
• B. Block stimulation of beta 1 and beta 2 at the receptor sites
• C. Block the conversion of angiotensin I to the vasoconstrictor angiotensin II
• D. None of the above

Correct answer: C

Rationale: ACE inhibitors work by inhibiting the conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor, and by blocking its production, ACE inhibitors help dilate blood vessels, reduce blood pressure, and decrease the workload of the heart. Choice A is incorrect because it describes the mechanism of action of angiotensin receptor blockers (ARBs), not ACE inhibitors. Choice B is incorrect as it describes beta-blockers, not ACE inhibitors. Choice D is incorrect as ACE inhibitors do have a specific mechanism of action.

3. A client is prescribed gentamicin for an infection. Which finding indicates a potential adverse reaction to the medication?

• A. Blood pressure 160/90 mm Hg
• B. Presence of red blood cells in the urine
• C. Urine output of 35 mL/hr
• D. Respiratory rate of 22/min

Correct answer: B

Rationale: The presence of red blood cells in the urine is a significant finding that can indicate nephrotoxicity, a potential adverse effect of gentamicin. Nephrotoxicity can lead to kidney damage, and monitoring for this adverse reaction is crucial during gentamicin therapy. Elevated blood pressure (Choice A) is not typically associated with gentamicin adverse reactions. Decreased urine output (Choice C) may suggest kidney impairment but is not as specific as the presence of red blood cells in the urine. Respiratory rate (Choice D) is not directly related to potential adverse reactions to gentamicin.

4. A client is receiving moderate sedation with Diazepam IV and is oversedated. Which of the following medications should the nurse anticipate administering to this client?

• A. Ketamine
• B. Naltrexone
• C. Flumazenil
• D. Fluvoxamine

Correct answer: C

Rationale: Flumazenil is a specific benzodiazepine antagonist that competitively reverses the sedative effects of benzodiazepines like Diazepam. In cases of oversedation or respiratory depression caused by benzodiazepines, administering Flumazenil can help reverse the effects and restore the client's consciousness and respiratory drive. Ketamine (Choice A) is a dissociative anesthetic and not used to reverse benzodiazepine sedation. Naltrexone (Choice B) is an opioid receptor antagonist and not indicated for benzodiazepine oversedation. Fluvoxamine (Choice D) is an antidepressant and not used to counteract benzodiazepine sedation.

5. What is the primary action of warfarin as an anticoagulant?

• A. Prevents the formation of blood clots
• B. Dissolves existing blood clots
• C. Dilates coronary arteries
• D. Treats rhythm disturbances

Correct answer: A

Rationale: The correct answer is A: "Prevents the formation of blood clots." Warfarin acts as an anticoagulant by inhibiting the synthesis of certain clotting factors in the liver. This action reduces the blood's ability to clot, making it effective in preventing the formation of blood clots. Choice B is incorrect because warfarin does not dissolve existing blood clots; it prevents their formation. Choice C is incorrect because warfarin's primary action is not to dilate coronary arteries. Choice D is incorrect as warfarin is not used to treat rhythm disturbances, but rather to prevent clot formation.

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