Nursing Elites

1. A client has a new prescription for Adalimumab for Rheumatoid Arthritis. Based on the route of administration of Adalimumab, which of the following should the nurse plan to monitor?

• A. The vein for thrombophlebitis during IV administration.
• B. The subcutaneous site for redness following injection.
• C. The oral mucosa for ulceration after oral administration.
• D. The skin for irritation following removal of transdermal patch.

Correct answer: B

Rationale: Adalimumab is administered subcutaneously for Rheumatoid Arthritis. Injection-site reactions such as redness and swelling are common. Therefore, the nurse should monitor the subcutaneous site for redness following the injection to assess for potential adverse effects.

2. While providing an Angiotensin-converting enzyme (ACE) inhibitor, the patient asks what the action of the drug is. As a healthcare provider, you explain that the action of an ACE inhibitor is:

• A. To lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II
• B. To inhibit reabsorption of sodium back into the body, ultimately increasing urine output and lowering blood pressure
• C. To decrease heart rate and blood pressure by competing with Beta1 and Beta2 receptors in the heart and lungs
• D. To lower blood glucose by stimulating the release of insulin

Correct answer: A

Rationale: ACE inhibitors lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II. Angiotensin II is a potent vasoconstrictor, and by inhibiting its formation, ACE inhibitors help dilate blood vessels, reduce blood pressure, and decrease the workload on the heart. Choice B is incorrect as it describes the mechanism of action of diuretics, not ACE inhibitors. Choice C is incorrect as it refers to the action of beta-blockers, not ACE inhibitors. Choice D is incorrect as it describes the mechanism of action of antidiabetic medications, not ACE inhibitors.

3. When providing discharge instructions to a client with a new prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Avoid salt substitutes.
• B. Take this medication at bedtime.
• C. Increase your intake of potassium-rich foods.
• D. Take this medication with food.

Correct answer: A

Rationale: The correct answer is to instruct the client to avoid salt substitutes. Lisinopril, an ACE inhibitor, can lead to hyperkalemia, so it is essential to avoid salt substitutes containing potassium, which can further increase potassium levels in the body. This instruction aims to prevent potential adverse effects and ensure the client's safety while taking Lisinopril. Choices B, C, and D are incorrect because Lisinopril is typically taken once a day in the morning, it can lead to hyperkalemia (so increasing potassium-rich foods is not advised), and it can be taken with or without food.

4. A healthcare provider is preparing to administer dextrose 5% in water (D5W) 750 mL IV to infuse over 6 hr. How many mL/hr should the IV pump be set to deliver?

• A. 125 mL/hr
• B. 100 mL/hr
• C. 150 mL/hr
• D. 200 mL/hr

Correct answer: A

Rationale: To calculate the flow rate, divide the total volume by the total time: (750 mL / 6 hr) = 125 mL/hr. Therefore, the IV pump should be set to deliver 125 mL/hr to infuse dextrose 5% in water (D5W) over 6 hours. Choice B, 100 mL/hr, is incorrect as it does not match the correct calculation. Choice C, 150 mL/hr, is incorrect as it is higher than the calculated flow rate. Choice D, 200 mL/hr, is incorrect as it is also higher than the calculated flow rate.

5. A client has a new prescription for Clonidine to assist with maintenance of abstinence from opioids. The nurse should instruct the client to monitor for which of the following adverse effects?

• A. Diarrhea
• B. Dry mouth
• C. Insomnia
• D. Hypertension

Correct answer: B

Rationale: Dry mouth is a common adverse effect associated with Clonidine use. Clonidine is known to cause a reduction in saliva production, leading to dry mouth. Monitoring for this adverse effect is essential to ensure client comfort and compliance with the medication. Diarrhea is not a common adverse effect of Clonidine. Insomnia is more commonly associated with opioid withdrawal rather than Clonidine use. While Clonidine is used to treat hypertension, it is not typically an adverse effect of the medication.

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