Nursing Elites

1. A client has a new prescription for Metoprolol. Which of the following instructions should the nurse include?

• A. Take this medication with food.
• B. Monitor for signs of hyperglycemia.
• C. Avoid sudden discontinuation of the medication.
• D. Increase your intake of potassium-rich foods.

Correct answer: C

Rationale: The correct answer is to instruct the client to avoid sudden discontinuation of Metoprolol. Metoprolol is a beta-blocker that should be tapered off gradually to prevent rebound hypertension and other cardiac issues. Abruptly stopping Metoprolol can lead to serious complications, so it is essential for the client to follow the healthcare provider's guidance on discontinuation. Choice A is incorrect because Metoprolol can be taken with or without food. Choice B is incorrect as Metoprolol is not typically associated with causing hyperglycemia. Choice D is also incorrect as there is no need to increase potassium-rich foods specifically due to taking Metoprolol.

2. A healthcare provider is planning to administer IV Alteplase to a client who is demonstrating manifestations of a massive Pulmonary Embolism. Which of the following interventions should the healthcare provider plan to take?

• A. Administer IM Enoxaparin along with the Alteplase dose.
• B. Hold direct pressure on puncture sites for up to 30 minutes.
• C. Administer Aminocaproic acid IV prior to alteplase infusion.
• D. Prepare to administer Alteplase within 8 hours of manifestation onset.

Correct answer: B

Rationale: When administering IV Alteplase for a massive Pulmonary Embolism, the healthcare provider should plan to hold direct pressure on puncture sites for 10 to 30 minutes or until oozing of blood stops. This is crucial to prevent bleeding complications at the puncture sites. Choice A is incorrect because Enoxaparin is not usually administered along with Alteplase for a Pulmonary Embolism. Choice C is incorrect because Aminocaproic acid is not typically given prior to alteplase infusion in this situation. Choice D is incorrect because Alteplase should be administered within 2 hours of onset of manifestations for Pulmonary Embolism, not within 8 hours.

3. A healthcare professional in an emergency unit is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. Which of the following findings is indicative of this condition?

• A. Insidious onset of painless loss of vision
• B. Gradual reduction in peripheral vision
• C. Severe pain around the eyes
• D. Intraocular pressure 12 mm Hg

Correct answer: C

Rationale: Severe pain around the eyes that radiates over the face is a classic symptom of acute angle-closure glaucoma. This intense pain is often associated with other symptoms such as blurred vision, halos around lights, redness in the eye, and sometimes nausea and vomiting. Immediate medical attention is required to prevent permanent vision loss. Choices A, B, and D are incorrect. Insidious onset of painless loss of vision is more indicative of conditions like macular degeneration. Gradual reduction in peripheral vision is commonly seen in conditions like open-angle glaucoma. An intraocular pressure of 12 mm Hg is within the normal range and is not typical of angle-closure glaucoma.

4. What is the pharmacological action of metformin?

• A. Blocks stimulation of beta1 and beta2.
• B. Blocks vasoconstriction and aldosterone.
• C. Acts at many levels in the CNS to produce an anxiolytic effect.
• D. Decreases hepatic glucose production.

Correct answer: D

Rationale: The correct answer is D: Decreases hepatic glucose production. Metformin's primary pharmacological action is to decrease hepatic glucose production, leading to lower blood sugar levels and improved insulin sensitivity in the liver. Choices A, B, and C are incorrect because metformin does not block stimulation of beta1 and beta2 receptors, vasoconstriction, aldosterone, or act in the CNS to produce an anxiolytic effect. Therefore, these options are not reflective of metformin's mechanism of action.

5. A client has a prescription for ceftriaxone. Which of the following information should the nurse include in the teaching?

• A. You may develop a cough while taking this medication.
• B. You should stop taking this medication if you develop a rash.
• C. This medication can be given orally.
• D. This medication may cause your urine to turn yellow.

Correct answer: B

Rationale: The correct answer is B. The nurse should instruct the client to discontinue ceftriaxone if a rash develops, as it could indicate an allergic reaction that needs to be reported to the healthcare provider for further evaluation and management. Choices A, C, and D are incorrect because cough development, oral administration, and yellow urine are not typically associated with ceftriaxone use and are not critical information that the nurse needs to emphasize in this scenario.

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