Nursing Elites

1. A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines the client has been self-administering St. John's wort, an herbal preparation, on the advice of a friend. What information is most significant about this finding?

• A. Wort can decrease plasma concentration of Cyclospora
• B. Wort can decrease plasma concentration of Tacrolimus
• C. Wort can decrease plasma concentration of Cyclosporine
• D. Wort can decrease plasma concentration of Mycophenolate

Correct answer: C

Rationale: The most significant information about the client self-administering St. John's wort, an herbal preparation, is that it can decrease the plasma concentration of Cyclosporine. St. John's wort is known to reduce the efficacy of Cyclosporine, which is a common immunosuppressant drug used to prevent transplant rejection. Choices A, B, and D are incorrect because St. John's wort does not affect the plasma concentration of Cyclospora, Tacrolimus, or Mycophenolate.

2. A client with a diagnosis of generalized anxiety disorder is prescribed lorazepam. The client should be informed that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Lorazepam, a medication commonly used to treat anxiety disorders, can lead to drowsiness as a common side effect. It is important for clients to be aware of this potential effect, and they should be advised to avoid activities like driving until they understand how the medication affects them. Dry mouth, nausea, and headache are possible side effects of other medications but are less commonly associated with lorazepam.

3. A client with type 2 diabetes mellitus is prescribed dulaglutide. The nurse should monitor for which potential adverse effect?

• A. Nausea
• B. Hypoglycemia
• C. Hyperglycemia
• D. Pancreatitis

Correct answer: A

Rationale: The correct answer is 'Nausea.' Dulaglutide, a medication commonly used in the management of type 2 diabetes, can lead to gastrointestinal side effects such as nausea. While hypoglycemia and hyperglycemia are potential concerns in diabetes management, they are not typically associated with dulaglutide use. Pancreatitis is a serious adverse effect of some diabetes medications, but it is not a common side effect of dulaglutide.

4. A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request?

• A. Determine if a take-home prescription for hydrocodone was provided and, if so, tell him to take one of them.
• B. Encourage him to wait until he is at home to take a medication that might impair reasoning.
• C. Give him a tablet from the hospital stock and tell him to wait until he is almost home to take it.
• D. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10.

Correct answer: D

Rationale: Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.

5. A client with severe rheumatoid arthritis is prescribed methotrexate. The nurse should monitor the client for which potential adverse effect?

• A. Bone marrow suppression
• B. Increased risk of infection
• C. Liver toxicity
• D. Kidney stones

Correct answer: A

Rationale: The correct answer is A: Bone marrow suppression. Methotrexate, commonly used in rheumatoid arthritis, can lead to bone marrow suppression, reducing the production of blood cells and increasing the risk of infection. Monitoring for signs of anemia, leukopenia, and thrombocytopenia is crucial to detect bone marrow suppression early and prevent complications. Choices B, C, and D are incorrect because while methotrexate can increase the risk of infection, liver toxicity, and kidney issues, the primary concern and most significant adverse effect to monitor for is bone marrow suppression due to its impact on blood cell production.

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