Nursing Elites

1. A client is receiving meperidine (Demerol) for pain management. Which assessment finding requires immediate action?

• A. Constipation
• B. Drowsiness
• C. Respiratory rate of 10 breaths per minute
• D. Nausea

Correct answer: C

Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a severe side effect of meperidine (Demerol) that necessitates immediate intervention to prevent further complications. Constipation, drowsiness, and nausea are common but less urgent side effects that do not pose an immediate life-threatening risk. Respiratory depression can lead to respiratory arrest and must be addressed promptly to ensure the client's safety and well-being.

2. When caring for a client with cancer receiving cisplatin, what adverse effects should the nurse monitor for? Select all that apply.

• A. Tinnitus
• B. Insomnia
• C. Hyperkalemia
• D. Hypercalcemia

Correct answer: A

Rationale: Cisplatin, a chemotherapy medication, can lead to various adverse effects, including ototoxicity manifesting as tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Therefore, the nurse should closely monitor for these side effects during the client's treatment.

3. The healthcare provider prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. What is the appropriate intervention for the nurse?

• A. Administer the medication within 60 minutes before the morning and evening meal.
• B. Withhold the medication and question the prescription with the healthcare provider.
• C. Monitor the client for gastrointestinal side effects after administration of the medication.
• D. Withdraw the insulin from the Penlet into an insulin syringe to prepare for administration.

Correct answer: B

Rationale: Exenatide (Byetta) is specifically indicated for the treatment of type 2 diabetes mellitus and is not recommended for clients with type 1 diabetes mellitus who are taking insulin. Choice A is incorrect because exenatide should not be administered to a client with type 1 diabetes mellitus who takes insulin. Choice C is not the most appropriate initial action when the prescription is not suitable for the client. Choice D is unrelated to the administration of exenatide. Therefore, the appropriate intervention for the nurse is to withhold the medication and question the prescription with the healthcare provider to ensure the safety and appropriateness of the treatment plan for the client.

4. A client with type 2 diabetes mellitus is prescribed glipizide (Glucotrol). Which instruction should the nurse include in the teaching plan?

• A. Take the medication before a meal.
• B. Monitor for signs of hypoglycemia.
• C. Avoid alcohol consumption while taking this medication.
• D. Take the medication before bedtime.

Correct answer: B

Rationale: The correct instruction the nurse should include in the teaching plan for a client prescribed glipizide (Glucotrol) is to monitor for signs of hypoglycemia. Glipizide stimulates insulin release from the pancreas, which can lead to hypoglycemia. It is usually taken before a meal, not necessarily on an empty stomach. Alcohol consumption should be avoided to prevent interactions with the medication. Taking the medication before bedtime is not the typical recommendation.

5. A healthcare professional is preparing to administer an intramuscular dose of penicillin to a client with a history of anaphylactic reactions to penicillin. Which action should the healthcare professional take first?

• A. Check the medication order for accuracy.
• B. Have an epinephrine injection available.
• C. Administer a test dose to check for a reaction.
• D. Ask the client about any allergies.

Correct answer: B

Rationale: When dealing with a client who has a history of anaphylactic reactions to penicillin, the priority action for the healthcare professional is to have an epinephrine injection readily available in case of a severe allergic reaction. In such cases, the immediate focus is on being prepared to manage a potentially life-threatening situation. While checking the medication order for accuracy, administering a test dose, and asking the client about allergies are essential steps in medication administration, the first priority is ensuring the availability of epinephrine to address a severe allergic reaction promptly.

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