Nursing Elites

1. A client has a new prescription for Clopidogrel. Which of the following instructions should the nurse include?

• A. Take this medication with food.
• B. Avoid taking aspirin while on this medication.
• C. Avoid eating foods high in potassium.
• D. Take this medication at bedtime.

Correct answer: B

Rationale: The correct answer is B: 'Avoid taking aspirin while on this medication.' Clopidogrel is an antiplatelet medication that can increase the risk of bleeding. Aspirin and other NSAIDs also affect platelet function and can further increase the risk of bleeding when combined with Clopidogrel. Therefore, it is important for the client to avoid taking aspirin while on this medication to reduce the risk of excessive bleeding. Choices A, C, and D are incorrect because there is no specific requirement to take Clopidogrel with food, avoid foods high in potassium, or take it at bedtime. The key instruction here is to avoid aspirin to prevent potential bleeding complications.

2. A healthcare professional is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the healthcare professional adjust the manual IV infusion to deliver?

• A. 22 gtt/min
• B. 24 gtt/min
• C. 20 gtt/min
• D. 18 gtt/min

Correct answer: A

Rationale: To determine the flow rate in drops per minute (gtt/min), you can use the formula: (Volume in mL x Drop factor) / Time in minutes = Flow rate in gtt/min. In this case, it would be (100 mL x 10 gtt/mL) / 45 min = 22 gtt/min. Therefore, the healthcare professional should adjust the manual IV infusion to deliver 22 gtt/min. Choice B, 24 gtt/min, is incorrect as it results from a miscalculation. Choices C and D, 20 gtt/min and 18 gtt/min respectively, are also incorrect calculations based on the given parameters.

3. When educating a client with a new prescription for Atorvastatin to treat Hyperlipidemia, which instruction should the nurse include?

• A. Take this medication in the morning.
• B. Avoid drinking grapefruit juice.
• C. Increase your intake of green, leafy vegetables.
• D. Expect your stools to turn clay-colored.

Correct answer: B

Rationale: The correct instruction for the nurse to include when educating a client with a new prescription for Atorvastatin to treat Hyperlipidemia is to avoid drinking grapefruit juice. Grapefruit juice can increase the blood levels of atorvastatin, leading to an elevated risk of serious side effects such as liver damage and muscle problems. It is essential for the client to be aware of this potential interaction and to follow the nurse's advice to avoid grapefruit juice while taking Atorvastatin. Choices A, C, and D are incorrect. Taking Atorvastatin in the morning is a common recommendation but not the priority over avoiding grapefruit juice. Increasing intake of green, leafy vegetables is generally a healthy dietary choice but is not specific to the medication. Expecting stools to turn clay-colored is not a common side effect of Atorvastatin.

4. What is the action of Metformin?

• A. Decreasing intestinal glucose absorption
• B. Increasing sensitivity to insulin
• C. Decreasing hepatic glucose production
• D. All of the above

Correct answer: D

Rationale: Metformin exerts its effects by decreasing hepatic glucose production, increasing sensitivity to insulin, and decreasing intestinal glucose absorption. These actions help in lowering blood glucose levels and improving insulin sensitivity in individuals with diabetes.

5. What should you monitor when administering Clopidogrel to a patient?

• A. Signs of thrombotic thrombocytopenic purpura
• B. Bleeding during therapy
• C. CBC with differential and platelet count
• D. All of the above

Correct answer: D

Rationale: When administering Clopidogrel, it is crucial to monitor for signs of thrombotic thrombocytopenic purpura, bleeding during therapy, and changes in CBC with differential and platelet count. Thrombotic thrombocytopenic purpura is a rare but serious condition associated with Clopidogrel use, characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and renal dysfunction. Monitoring for signs of thrombotic thrombocytopenic purpura is essential to detect this potentially life-threatening condition early. Monitoring for bleeding helps to assess the risk of hemorrhagic events, a known side effect of Clopidogrel. Additionally, regular monitoring of CBC with differential and platelet count is necessary to evaluate the drug's impact on blood cell counts and detect any abnormalities that may require intervention. Therefore, monitoring all these parameters is vital to ensure patient safety and appropriate management during Clopidogrel therapy.

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