Nursing Elites

1. A client has been prescribed Phenelzine for depression. Which of the following indicates that the client has developed an adverse effect of this medication?

• A. Orthostatic hypotension
• B. Hearing loss
• C. Gastrointestinal bleeding
• D. Weight loss

Correct answer: A

Rationale: Orthostatic hypotension is a known adverse effect of Phenelzine, a monoamine oxidase inhibitor (MAOI) used for depression. It is caused by a sudden drop in blood pressure when changing positions, leading to symptoms like dizziness or fainting. Monitoring for orthostatic hypotension is crucial during Phenelzine therapy to prevent complications. Choices B, C, and D are incorrect because hearing loss, gastrointestinal bleeding, and weight loss are not typically associated with Phenelzine use.

2. A client with increased intracranial pressure is receiving Mannitol. Which finding should the nurse report to the provider?

• A. Blood glucose 150 mg/dL
• B. Urine output 40 mL/hr
• C. Dyspnea
• D. Bilateral equal pupil size

Correct answer: C

Rationale: The correct answer is C: Dyspnea. Dyspnea is a concerning finding in a client receiving Mannitol as it can be a manifestation of heart failure, which is an adverse effect of the medication. The nurse should promptly notify the provider, discontinue the Mannitol, and initiate appropriate interventions to address the dyspnea and monitor the client's condition closely. Choice A, Blood glucose of 150 mg/dL, is within normal limits and not directly related to Mannitol administration. Choice B, Urine output of 40 mL/hr, could indicate decreased renal perfusion, but it is not the most critical finding compared to dyspnea. Choice D, Bilateral equal pupil size, is a normal neurological finding and not directly related to Mannitol therapy.

3. A client in a long-term care facility has Hypothyroidism and a new prescription for Levothyroxine. Which of the following dosage schedules should the nurse expect for this client?

• A. The client will start at a high dose, and the dose will be tapered as needed.
• B. The client will remain on the initial dosage during the course of treatment.
• C. The client's dosage will be adjusted daily based on blood levels.
• D. The client will start on a low dose, which will be gradually increased.

Correct answer: D

Rationale: Levothyroxine should be initiated at a low dose and titrated gradually over several weeks to achieve therapeutic levels. This approach helps to minimize the risk of adverse effects, particularly in older adult clients who may be more sensitive to medication changes. Starting at a low dose allows for close monitoring of the client's response and adjustment of the dosage as needed to optimize treatment outcomes. Choice A is incorrect because starting at a high dose can increase the risk of adverse effects and is not the recommended approach. Choice B is incorrect because maintaining the initial dosage throughout the treatment may not achieve optimal therapeutic levels. Choice C is incorrect because adjusting the dosage daily based on blood levels is not the standard practice for initiating Levothyroxine treatment.

4. A client has a new prescription for Warfarin. Which of the following herbal supplements should the client be instructed to avoid?

• A. St. John's wort
• B. Echinacea
• C. Garlic
• D. Ginseng

Correct answer: A

Rationale: St. John's wort should be avoided by clients taking Warfarin as it can reduce the medication's effectiveness by affecting its metabolism. Echinacea, garlic, and ginseng are also known to interact with Warfarin, either by increasing the risk of bleeding or altering its anticoagulant effects. However, St. John's wort is particularly significant due to its potent enzyme-inducing properties that can lead to subtherapeutic levels of Warfarin, potentially increasing the risk of blood clots.

5. A client has a new prescription for Pancrelipase for chronic pancreatitis. Which of the following instructions should be included by the nurse?

• A. Take the medication with meals and snacks.
• B. Chew the tablet thoroughly before swallowing.
• C. Take the medication 1 hour before meals.
• D. Expect the stool to be yellow.

Correct answer: A

Rationale: The correct instruction for taking Pancrelipase is to take it with meals and snacks to aid in the digestion of fats, proteins, and carbohydrates. This helps optimize the effectiveness of the medication in managing chronic pancreatitis. Choice B is incorrect because Pancrelipase should not be chewed but swallowed whole. Choice C is incorrect as the medication should be taken with meals. Choice D is incorrect because while Pancrelipase can cause stool changes, yellow stool is not an expected outcome.

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