Nursing Elites

1. A client with a diagnosis of bipolar disorder is prescribed topiramate. The nurse should monitor for which potential adverse effect?

• A. Cognitive impairment
• B. Weight gain
• C. Liver toxicity
• D. Weight loss

Correct answer: A

Rationale: Correct. Topiramate is associated with cognitive impairment as an adverse effect. It is important for the nurse to monitor the client's cognitive function while on this medication to assess for any signs of cognitive decline or impairment. Choice B, weight gain, is incorrect as topiramate is actually associated with weight loss rather than weight gain. Choice C, liver toxicity, is also incorrect as topiramate is not known to cause liver toxicity. Choice D, weight loss, is not the correct answer as topiramate is not associated with weight gain.

2. A client has been diagnosed with open-angle glaucoma. The healthcare provider prescribes pilocarpine 1% eye drops. The nurse explains that which action of this drug makes it a useful treatment for the client's condition?

• A. The ciliary muscle contracts, increasing the outflow of aqueous humor in the eye.
• B. Ciliary muscles are paralyzed to decrease accommodation.
• C. Bilateral mydriasis with cycloplegia is accomplished.
• D. The production of aqueous humor in the eyes is decreased.

Correct answer: A

Rationale: Pilocarpine, a cholinergic agent, stimulates the ciliary muscle to contract, which opens the trabecular meshwork and facilitates the outflow of aqueous humor, reducing intraocular pressure. This mechanism helps in managing open-angle glaucoma by improving drainage and lowering pressure within the eye. Choice A is correct because the contraction of the ciliary muscle increases the outflow of aqueous humor, aiding in the treatment of open-angle glaucoma. Choices B, C, and D are incorrect because they do not describe the mechanism of action of pilocarpine in treating glaucoma.

3. A client has been prescribed losartan. Which change in data indicates to the practical nurse (PN) that the desired effect of this medication has been achieved?

• A. Dependent edema reduced from +3 to +1.
• B. Serum HDL increased from 35 to 55 mg/dL.
• C. Pulse rate reduced from 150 to 90 beats/min.
• D. Blood pressure reduced from 160/90 to 130/80 mm Hg.

Correct answer: D

Rationale: The correct answer is D. Losartan is prescribed for the treatment of hypertension. The desired effect of losartan is to reduce blood pressure. Therefore, a reduction in blood pressure from 160/90 to 130/80 mm Hg indicates that the desired effect of the medication has been achieved. Choices A, B, and C are not specific effects of losartan and do not directly relate to the expected outcomes of this medication. Dependent edema, serum HDL levels, and pulse rate are not typically influenced by losartan, making choices A, B, and C incorrect.

4. A client with type 2 diabetes is prescribed metformin. What instruction should the practical nurse (PN) include in the client's teaching plan?

• A. Take the medication with meals to decrease gastrointestinal upset.
• B. Take the medication with a full glass of water.
• C. Avoid alcohol while taking the medication.
• D. Take the medication with meals to increase absorption.

Correct answer: B

Rationale: The correct instruction for a client prescribed metformin is to take the medication with a full glass of water. This helps ensure proper ingestion and absorption of the medication. While taking metformin with meals can help reduce gastrointestinal side effects, the primary focus should be on adequate hydration and absorption by taking it with water. Avoiding alcohol while taking metformin is also important as alcohol can increase the risk of lactic acidosis when combined with metformin. Taking the medication with meals to increase absorption is incorrect as metformin should be taken with food to reduce gastrointestinal upset, not to increase absorption.

5. During a home visit, a client with a history of angina reports frequent headaches. The client recently started a new prescription for diltiazem, a calcium channel blocker. What action should the nurse take?

• A. Explain the importance of obtaining a blood sample promptly to test for medication toxicity
• B. Consult with the healthcare provider regarding the necessity of an opioid analgesic for pain relief
• C. Recommend the client to discontinue the medication until contacting the healthcare provider
• D. Instruct the client on the use of acetaminophen every 4-6 hours as needed for headaches

Correct answer: D

Rationale: The correct action for the nurse to take is to instruct the client to use acetaminophen for headaches. Acetaminophen is a suitable and safer option for managing headaches associated with calcium channel blockers like diltiazem. It is essential to avoid medications that can interact negatively with diltiazem, such as opioid analgesics. Discontinuing the medication abruptly without consulting the healthcare provider is not recommended. Monitoring for medication toxicity through blood samples is not typically indicated for managing headaches in this scenario.

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