Nursing Elites

1. When starting therapy with raloxifene, a client should monitor for which of the following adverse effects?

• A. Leg cramps
• B. Hot flashes
• C. Urinary frequency
• D. Hair loss

Correct answer: B

Rationale: The correct answer is B: Hot flashes. When initiating therapy with raloxifene, clients should be advised to monitor for hot flashes as they are a common adverse effect associated with this medication. Hot flashes are a well-known side effect of raloxifene due to its action on estrogen receptors. Leg cramps (Choice A), urinary frequency (Choice C), and hair loss (Choice D) are not typically associated with raloxifene therapy. Therefore, monitoring for hot flashes is crucial to manage and address this common side effect appropriately.

2. What is the expected outcome of Valproate therapy?

• A. Decreased fever
• B. Decreased sense of anxiety
• C. Decreased blood pressure
• D. Decreased seizure activity

Correct answer: D

Rationale: The correct answer is D: Decreased seizure activity. Valproate is commonly used in the treatment of epilepsy to help control and reduce seizure frequency. Choices A, B, and C are incorrect because Valproate is not primarily used to treat fever, anxiety, or blood pressure issues.

3. A client has a new prescription for methotrexate to treat Rheumatoid Arthritis. The nurse should expect to monitor the client for which of the following adverse effects?

• A. Insomnia
• B. Hypertension
• C. Bone marrow suppression
• D. Constipation

Correct answer: C

Rationale: The correct answer is bone marrow suppression (Choice C). Methotrexate can lead to bone marrow suppression, resulting in adverse effects such as anemia, leukopenia, and thrombocytopenia. Monitoring for signs of decreased blood cell counts is essential to prevent complications and adjust treatment as needed. Choices A, B, and D are incorrect. Insomnia, hypertension, and constipation are not typically associated with methotrexate use in the treatment of Rheumatoid Arthritis.

4. The healthcare professional is preparing to administer atenolol (Tenormin) to a client with angina. Which vital sign would cause the healthcare professional to question administering this drug?

• A. Respirations 12 breaths per minute
• B. Pulse 52 beats per minute
• C. Blood pressure 134/72
• D. Oxygen saturation 95%

Correct answer: B

Rationale: Atenolol is a beta-blocker medication that can lower heart rate. A pulse of 52 beats per minute is relatively low and administering atenolol could further decrease the heart rate, potentially leading to bradycardia. Monitoring the pulse rate and holding the medication if the pulse is below the prescribed parameters is crucial to prevent adverse effects such as bradycardia and hypotension.

5. Which drug undergoes extensive first-pass hepatic metabolism?

• A. Heparin
• B. Insulin
• C. Propranolol
• D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

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