Nursing Elites

1. A client has been taking a drug (Drug A) that is highly metabolized by the cytochrome P-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome P-450 system. You should monitor this client for:

• A. increased therapeutic effects of Drug A.
• B. increased adverse effects of Drug B.
• C. decreased therapeutic effects of Drug A.
• D. decreased therapeutic effects of Drug B.

Correct answer: C

Rationale: When a client is taking a drug (Drug A) metabolized by the cytochrome P-450 system and is then started on another drug (Drug B) that induces this system, the metabolism of Drug A is increased. This results in decreased therapeutic effects of Drug A as it is broken down more rapidly. Monitoring is required to address potential reduced efficacy. The therapeutic effect of Drug A is diminished, not enhanced. Inducing the cytochrome P-450 system does not directly increase the adverse effects of Drug B. Although Drug B is an inducer, its therapeutic effects are not decreased as it is not metabolized faster.

2. A nurse working in a surgical unit notices a patient experiencing SOB, calf pain, and warmth over the posterior calf. All of these symptoms may indicate which of the following medical conditions?

• A. Patient may have a DVT.
• B. Patient may be exhibiting signs of dermatitis.
• C. Patient may be in the late stages of CHF.
• D. Patient may be experiencing anxiety after surgery.

Correct answer: A

Rationale: The correct answer is that the patient may have a DVT (Deep Vein Thrombosis). SOB (Shortness of Breath), calf pain, and warmth over the posterior calf are classic signs and symptoms of DVT. DVT is a serious condition where a blood clot forms in a deep vein, commonly in the legs. Choices B, C, and D are incorrect because dermatitis does not typically present with these symptoms, late stages of CHF would manifest with other signs, and anxiety after surgery usually does not produce these specific symptoms.

3. The PN is caring for a client with diabetes insipidus. The nurse can expect the lab work to show:

• A. elevated urine osmolarity and elevated serum osmolarity.
• B. decreased urine osmolarity and decreased serum osmolarity.
• C. elevated urine osmolarity and decreased serum osmolarity.
• D. decreased urine osmolarity and elevated serum osmolarity.

Correct answer: D

Rationale: In diabetes insipidus, the pituitary releases too much antidiuretic hormone (ADH), causing the client to produce a large amount of dilute urine (decreased osmolarity) and leading to dehydration (elevated serum osmolarity). Therefore, the correct answer is decreased urine osmolarity and elevated serum osmolarity. Choice C, elevated urine osmolarity and decreased serum osmolarity, is incorrect for diabetes insipidus, as it is more characteristic of syndrome of inappropriate ADH (SIADH). Choices A and B, elevated urine osmolarity and elevated serum osmolarity, and decreased urine osmolarity and decreased serum osmolarity, respectively, are generally not seen in diabetes insipidus, as urine and serum osmolarity typically move in opposite directions in this condition.

4. The client with peripheral vascular disease is reviewing self-care measures. Which of the following statements indicates proper self-care measures?

• A. "I like to soak my feet in the hot tub every day."?
• B. "I walk to the mailbox in my bare feet."?
• C. "I stopped smoking and only use chewing tobacco."?
• D. "I have my wife examine the soles of my feet each day."?

Correct answer: D

Rationale: The correct answer is, "I have my wife examine the soles of my feet each day."? Clients with peripheral vascular disease should examine their feet daily for any signs of redness, dryness, or cuts. If the client is unable to do this themselves due to decreased sensation in their feet, a caregiver or family member should assist. Soaking feet in a hot tub should be avoided as the client may not be able to sense if the water is too hot, potentially causing burns. Walking barefoot can lead to injuries, so wearing shoes or slippers is recommended to minimize trauma. While quitting smoking is a positive step, using chewing tobacco can still constrict blood vessels, adversely affecting circulation in the extremities.

5. A month after receiving a blood transfusion, an immunocompromised client develops fever, liver abnormalities, a rash, and diarrhea. The nurse should suspect this client has:

• A. no relation to the blood transfusion.
• B. graft-versus-host disease (GVHD).
• C. myelosuppression.
• D. an allergic reaction to a recent medication.

Correct answer: B

Rationale: In this scenario, the symptoms of fever, liver abnormalities, rash, and diarrhea in an immunocompromised client a month after a blood transfusion are indicative of graft-versus-host disease (GVHD). GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can manifest within a month of the transfusion. While choices 1 and 4 are plausible, it is crucial for the nurse to consider the possibility of GVHD in immunocompromised transfusion recipients due to the significant risk. Myelosuppression, choice C, typically presents with decreased blood cell counts and is not consistent with the symptoms described. An allergic reaction to medication, choice D, would present with different manifestations such as itching, hives, or anaphylaxis, which are not described in the scenario.

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