Nursing Elites

1. A client is prescribed verapamil for hypertension. The nurse should monitor the client for which common adverse effect?

• A. Constipation
• B. Headache
• C. Muscle cramping
• D. Fatigue

Correct answer: A

Rationale: Verapamil, a calcium channel blocker commonly used for hypertension, is known to cause constipation as a frequent adverse effect. This occurs due to its effects on smooth muscle relaxation in the gastrointestinal tract, leading to decreased motility. Headache, muscle cramping, and fatigue are not typically associated with verapamil use and are less common side effects. Therefore, the nurse should closely monitor the client for symptoms of constipation when administering verapamil.

2. A client is prescribed nitroglycerin sublingual tablets. The practical nurse should reinforce which instruction?

• A. Store the tablets in a cool, dry place.
• B. Take one tablet every 5 minutes until pain is relieved, up to three tablets.
• C. Swallow the tablets whole.
• D. Chew the tablets for faster relief.

Correct answer: A

Rationale: Nitroglycerin sublingual tablets are sensitive to heat and moisture, so they should be stored in a cool, dry place to maintain their efficacy. Storing them in a cool, dry place helps prevent degradation of the medication. Choice B is incorrect because nitroglycerin tablets should be taken as directed by the healthcare provider to avoid potential overdose or adverse effects. Choice C is incorrect because sublingual tablets should be placed under the tongue to dissolve and be absorbed, not swallowed, to ensure their quick action. Choice D is incorrect because sublingual tablets should not be chewed; they are meant to be absorbed through the tissues under the tongue, and chewing them may alter their effectiveness.

3. A client is prescribed methylprednisolone for an allergic reaction. The nurse should monitor for which potential side effect of this medication?

• A. Nausea and vomiting
• B. Weight gain
• C. Insomnia
• D. Increased appetite

Correct answer: B

Rationale: When a client is prescribed methylprednisolone, a corticosteroid, the nurse should monitor for weight gain as a potential side effect. Corticosteroids like methylprednisolone can cause weight gain and fluid retention due to their impact on metabolism and sodium retention. Nausea and vomiting are less common side effects of methylprednisolone. Insomnia and increased appetite are not typically associated with methylprednisolone use.

4. A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

• A. Dilute the available heparin in 250ml of normal saline solution prior to IV administration
• B. Advise the pharmacy on the need to deliver a vial of heparin to the nursing unit immediately
• C. Calculate and administer the equivalent dose of the available low molecular weight heparin
• D. Request a prescription to change the route of administration and use the available heparin

Correct answer: B

Rationale: In this scenario, the nurse should contact the pharmacy to obtain the correct heparin formulation as the prescription calls for heparin 1,000 units IV STAT. Low molecular weight heparin is not the same as unfractionated heparin, and therefore, the nurse should not administer the available low molecular weight heparin without first obtaining the correct medication. Diluting the available heparin, calculating an equivalent dose, or changing the route of administration would not address the discrepancy between the prescribed heparin and the available low molecular weight heparin.

5. A client taking long-term steroids also has ranitidine prescribed. The nurse provides which explanation as to why these drugs are given together?

• A. Ranitidine reduces the risk of ulcers associated with steroids.
• B. Ranitidine decreases the risk of infection associated with steroids.
• C. Ranitidine decreases blood sugar elevations associated with steroids.
• D. Ranitidine reduces sodium retention associated with steroid usage.

Correct answer: A

Rationale: The correct answer is A. Ranitidine is prescribed with long-term steroids to reduce the risk of ulcers associated with steroid therapy. Although steroids can increase the risk of ulcers due to their effect on the gastrointestinal system, ranitidine works by reducing stomach acid production, thus helping to prevent ulcer formation. Choices B, C, and D are incorrect as ranitidine is not given to decrease the risk of infection, reduce blood sugar elevations, or reduce sodium retention associated with steroid usage.

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