Nursing Elites

1. A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take?

• A. Obtain a blood specimen immediately prior to administering the next dose of medication.
• B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen.
• C. Ask the client to provide a urine specimen after the next dose of medication.
• D. Administer the medication and obtain a blood specimen 30 minutes later.

Correct answer: A

Rationale: To verify the trough levels of a medication accurately, the nurse should obtain a blood specimen immediately before administering the next dose of the medication. The trough level represents the lowest concentration of the medication in the bloodstream, typically right before the next dose is due. This timing ensures an accurate assessment of the drug's concentration in the body at its lowest point, aiding in determining the drug's effectiveness and potential toxicity levels. Choice B is incorrect because waiting for 24 hours would not provide the trough level. Choice C is incorrect as urine specimens are not used to measure trough levels. Choice D is incorrect as obtaining a blood specimen 30 minutes after administering the medication would not reflect the trough level.

2. What should you monitor when administering Clopidogrel to a patient?

• A. Signs of thrombotic thrombocytopenic purpura
• B. Bleeding during therapy
• C. CBC with differential and platelet count
• D. All of the above

Correct answer: D

Rationale: When administering Clopidogrel, it is crucial to monitor for signs of thrombotic thrombocytopenic purpura, bleeding during therapy, and changes in CBC with differential and platelet count. Thrombotic thrombocytopenic purpura is a rare but serious condition associated with Clopidogrel use, characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and renal dysfunction. Monitoring for signs of thrombotic thrombocytopenic purpura is essential to detect this potentially life-threatening condition early. Monitoring for bleeding helps to assess the risk of hemorrhagic events, a known side effect of Clopidogrel. Additionally, regular monitoring of CBC with differential and platelet count is necessary to evaluate the drug's impact on blood cell counts and detect any abnormalities that may require intervention. Therefore, monitoring all these parameters is vital to ensure patient safety and appropriate management during Clopidogrel therapy.

3. Phenytoin is an antiarrhythmic and anticonvulsant that has an unlabeled use for:

• A. Headaches
• B. Cold remedy
• C. Neuropathic pain
• D. Antianxiety

Correct answer: C

Rationale: Phenytoin, an antiarrhythmic and anticonvulsant medication, is also used off-label for treating neuropathic pain. While its primary indications are for managing heart rhythm disorders and seizures, it has shown efficacy in managing neuropathic pain, expanding its clinical utility. Choices A, B, and D are incorrect as phenytoin is not commonly used for headaches, cold remedies, or antianxiety purposes.

4. A client has a new prescription for Brimonidine ophthalmic drops and wears soft contact lenses. Which of the following instructions should the nurse include in the teaching?

• A. This medication can stain your contacts.
• B. This medication can cause your pupils to constrict.
• C. This medication can absorb into your contacts.
• D. This medication can slow your heart rate.

Correct answer: C

Rationale: The correct instruction the nurse should include is that Brimonidine can absorb into soft contact lenses. To prevent this, the client should remove the contacts, instill the medication, and wait at least 15 minutes before putting the contacts back in to avoid any potential absorption of the medication into the lenses. Choices A, B, and D are incorrect because Brimonidine is not known to stain contacts, cause pupil constriction, or slow heart rate.

5. A client with chronic Neutropenia is receiving Filgrastim. What action should the nurse take to assess for an adverse effect of filgrastim?

• A. Assess for bone pain.
• B. Assess for right lower quadrant pain.
• C. Auscultate for crackles in the bases of the lungs.
• D. Auscultate the chest to listen for a heart murmur.

Correct answer: A

Rationale: Bone pain is a known adverse effect of Filgrastim, which is dose-related. By assessing for bone pain, the nurse can monitor for this common side effect. Acetaminophen and, if necessary, an opioid analgesic can be used to manage the bone pain associated with Filgrastim. Assessing for right lower quadrant pain, crackles in the bases of the lungs, or heart murmurs would not directly relate to the adverse effects of Filgrastim in a client with chronic Neutropenia.

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