Nursing Elites

1. During a screening on a patient with a recent cast on the left lower extremity, which of the following statements should the nurse be most concerned about?

• A. The patient reports, "I didn't keep my extremity elevated as the doctor asked me to."?
• B. The patient reports, "I have been having pain in my left calf."?
• C. The patient reports, "My left leg has really been itching."?
• D. The patient reports, "The arthritis in my wrists is flaring up when I put weight on my crutches."?

Correct answer: B

Rationale: The correct answer is B because pain in the left calf could indicate a potential neurovascular complication related to the casted extremity. It could suggest issues such as compartment syndrome or impaired circulation. Option A is not as concerning since not elevating the extremity may lead to swelling but is not an immediate concern. Option C indicates itching, which is common with casts and not as concerning as potential neurovascular issues. Option D, regarding arthritis in the wrists, is unrelated to the lower extremity issue being screened for.

2. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a maintenance dose.
• B. a loading dose.
• C. a medication with no first-pass effect.
• D. the medication to be given intravenously.

Correct answer: B

Rationale: To rapidly achieve a therapeutic plasma drug concentration, a loading or priming dose is ordered. This dose quickly establishes the desired drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose, like choice A, is used to maintain the therapeutic level after the loading dose. Waiting for steady state without a loading dose would take five drug half-lives. Choice C, a medication with no first-pass effect, does not directly address the need for rapid attainment of therapeutic levels. While intravenous administration (choice D) offers excellent bioavailability, a single dose by this route may not achieve the desired therapeutic plasma concentration as rapidly as a loading dose.

3. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?

• A. Hypertension
• B. Hyperkalemia
• C. Bradycardia
• D. Arthralgia

Correct answer: C

Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.

4. A patient has been admitted to the hospital with an L4-5 HNP diagnosis. After 24 hours, the patient is able to ambulate with assistance and has reduced muscle spasms. Which of the following medications was the most beneficial in changing the patient's mobility status?

• A. Mivacron
• B. Atropine
• C. Bethanechol
• D. Flexeril

Correct answer: D

Rationale: The correct answer is Flexeril. Flexeril is a muscle relaxant commonly used to treat acute muscle pain and spasms. In this scenario, the patient experiencing reduced muscle spasms and improved mobility after taking Flexeril indicates its effectiveness. Choice A, Mivacron, is a neuromuscular blocking agent that is not typically used for muscle spasms or pain relief. Choice B, Atropine, is a medication used to treat certain types of nerve agent and pesticide poisonings, not muscle spasms. Choice C, Bethanechol, is a medication that stimulates bladder contractions and is not indicated for muscle spasms or mobility improvement.

5. Which of the following medications is a serotonin antagonist that might be used to relieve nausea and vomiting?

• A. metoclopramide (Reglan)
• B. ondansetron (Zofran)
• C. hydroxyzine (Vistaril)
• D. prochlorperazine (Compazine)

Correct answer: B

Rationale: Zofran is a serotonin antagonist commonly used to relieve nausea and vomiting by blocking serotonin receptors. Metoclopramide (Reglan) acts on dopamine receptors, hydroxyzine (Vistaril) is an antihistamine, and prochlorperazine (Compazine) is a dopamine antagonist. While these medications can also be used for nausea and vomiting, they do not primarily function as serotonin antagonists like ondansetron.

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