Nursing Elites

1. A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?

• A. Reduced cardiac function
• B. First-pass effect
• C. Reduced hepatic function
• D. Increased gastric motility

Correct answer: C

Rationale: In older adults, reduced hepatic function can lead to prolonged effects of medications metabolized by the liver. This situation can result in increased drug levels in the body, causing drowsiness and other side effects. Adjusting the dosage of the hypnotic medication may be necessary to prevent such adverse effects in older adult clients. Choice A, reduced cardiac function, is not directly related to the metabolism of the medication and is unlikely to cause drowsiness. Choice B, first-pass effect, refers to the initial metabolism of a drug in the liver before it enters circulation, but it is not the cause of drowsiness in this scenario. Choice D, increased gastric motility, does not play a significant role in the metabolism of the medication and is not a likely cause of the client's drowsiness.

2. Which of the following conditions are not treated with opioid analgesics like dextromethorphan and methadone?

• A. Pulmonary Edema
• B. Cough suppression
• C. Sedation
• D. Pain

Correct answer: C

Rationale: Opioid analgesics like dextromethorphan and methadone are primarily used for pain management and cough suppression. Sedation is not a primary indication for these medications.

3. Hydrochlorothiazide is classified as a

• A. Anti-inflammatory
• B. Antiarrhythmic
• C. Diuretic
• D. Antifungal

Correct answer: C

Rationale: Hydrochlorothiazide is classified as a diuretic. Diuretics are medications that help the body get rid of excess salt and water by increasing urine production, reducing fluid retention, and lowering blood pressure. Option A, Anti-inflammatory, is incorrect because hydrochlorothiazide does not primarily reduce inflammation. Option B, Antiarrhythmic, is incorrect because hydrochlorothiazide is not used to correct heart rhythm irregularities. Option D, Antifungal, is incorrect because hydrochlorothiazide is not used to treat fungal infections.

4. When educating a client starting a new prescription for metoprolol, which instruction should the nurse include?

• A. Check your pulse before taking the medication.
• B. Take the medication with food to increase absorption.
• C. Avoid sudden changes in position.
• D. Monitor your blood pressure regularly.

Correct answer: C

Rationale: The correct instruction for a client starting metoprolol is to avoid sudden changes in position. Metoprolol can cause dizziness due to its blood pressure-lowering effects, increasing the risk of falls and injury. Instructing the client to change positions slowly helps prevent orthostatic hypotension and related adverse events. Checking the pulse before taking the medication (Choice A) is not typically necessary for metoprolol. Taking the medication with food (Choice B) is not required for absorption and can be taken with or without food. Monitoring blood pressure regularly (Choice D) is essential for clients taking metoprolol, but avoiding sudden changes in position is more critical to prevent dizziness and falls.

5. A nurse is evaluating teaching for a client who has Rheumatoid Arthritis and a new prescription for Methotrexate. Which of the following statements by the client indicates understanding of the teaching?

• A. I will be sure to return to the clinic at least once a year to have my blood drawn while I'm taking methotrexate.
• B. I will take this medication on an empty stomach.
• C. I'll let the doctor know if I develop sores in my mouth while taking this medication.
• D. I should stop taking oral contraceptives while I'm taking methotrexate.

Correct answer: C

Rationale: Ulcerations in the mouth, tongue, or throat are often the first signs of methotrexate toxicity and should be reported to the provider immediately.

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