Nursing Elites

1. A client is prescribed amitriptyline for depression. The practical nurse (PN) should monitor for which potential side effect?

• A. Insomnia
• B. Weight loss
• C. Dry mouth
• D. Increased appetite

Correct answer: D

Rationale: The correct answer is 'D: Increased appetite.' Amitriptyline, a tricyclic antidepressant, is known to commonly cause increased appetite, leading to weight gain. Monitoring for increased appetite is crucial as it can impact the client's overall health and well-being. Choice A, 'Insomnia,' is less likely as amitriptyline is more associated with sedative effects. Choice B, 'Weight loss,' is incorrect as weight gain is a more common side effect. Choice C, 'Dry mouth,' is a potential side effect of amitriptyline, but it is not directly related to increased appetite, which is the primary concern in this case.

2. The patient is prescribed cimetidine (Tagamet) orally. What should the nurse consider about administering this drug?

• A. Administer the drug with the first bite of food
• B. Administer the drug immediately after meals
• C. Administer the drug 30 minutes after meals
• D. Administer the drug 30 minutes before meals

Correct answer: D

Rationale: Cimetidine is best absorbed when taken 30 minutes before meals to decrease stomach acid. Administering it before meals allows for optimal absorption and effectiveness of the medication. Choices A, B, and C are incorrect because administering cimetidine with food, immediately after meals, or 30 minutes after meals may not provide the best conditions for absorption. Taking it before meals ensures that the drug is absorbed properly and can exert its intended effects.

3. A client with a history of myocardial infarction is prescribed atorvastatin. The nurse should monitor the client for which potential adverse effect?

• A. Liver damage
• B. Kidney damage
• C. Muscle pain
• D. Increased appetite

Correct answer: C

Rationale: The correct answer is C: Muscle pain. Atorvastatin can cause muscle pain, which may indicate rhabdomyolysis, a serious adverse effect. Rhabdomyolysis is a condition where muscle breakdown releases a protein (myoglobin) into the bloodstream, potentially leading to kidney damage. Liver damage (choice A) is a less common side effect of atorvastatin compared to muscle pain. Kidney damage (choice B) is not a direct adverse effect of atorvastatin but can occur indirectly if rhabdomyolysis is severe. Increased appetite (choice D) is not a known adverse effect of atorvastatin.

4. The healthcare professional is caring for a patient with a new order for an oral laxative. Which is a contraindication in administering an oral laxative?

• A. Cardiac problems
• B. Abdominal pain of unknown origin
• C. Several hemorrhoids
• D. Chronic constipation

Correct answer: B

Rationale: Administering an oral laxative to a patient with abdominal pain of unknown origin is contraindicated because it could be a sign of a more serious underlying condition that needs immediate medical evaluation. Giving a laxative in such a situation without proper diagnosis could potentially worsen the patient's condition or delay appropriate treatment. Choice A (Cardiac problems) is not a contraindication for an oral laxative unless the patient has a specific cardiac condition that interacts with the laxative. Choice C (Several hemorrhoids) and Choice D (Chronic constipation) are not contraindications for administering an oral laxative.

5. A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention for signs of digoxin toxicity?

• A. Apical heart rate of 60 beats/min
• B. Sweating across the forehead
• C. Poor sucking effort
• D. Respiratory rate of 30 breaths/min

Correct answer: A

Rationale: A heart rate of 60 beats/min for a 6-month-old infant warrants immediate intervention as it falls below the normal range. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered within normal limits. Bradycardia (heart rate <60 beats/min) in infants can be a sign of digoxin toxicity, necessitating prompt evaluation and intervention to prevent adverse effects. Sweating across the forehead (Choice B) is a non-specific symptom and may not directly indicate digoxin toxicity. Poor sucking effort (Choice C) and a respiratory rate of 30 breaths/min (Choice D) are not typically associated with digoxin toxicity and do not require immediate intervention in the context of this question.

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