Nursing Elites

1. A patient states he experiences anxiety and has panic attacks at least once a week. What might be helpful for this patient?

• A. Phenytoin (Dilantin)
• B. Lithium
• C. Alprazolam (Xanax)
• D. Spironolactone

Correct answer: C

Rationale: Alprazolam (Xanax) is a medication commonly prescribed to treat anxiety disorders and panic attacks. It belongs to the class of medications known as benzodiazepines, which work by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain to produce a calming effect. Phenytoin is an antiepileptic drug, not typically used for anxiety or panic attacks. Lithium is primarily used to treat bipolar disorder, not anxiety. Spironolactone is a diuretic primarily used to treat conditions like high blood pressure and heart failure, not anxiety or panic attacks.

2. A healthcare provider is providing teaching to a client who is starting therapy with paclitaxel. Which of the following adverse effects should the healthcare provider instruct the client to monitor?

• A. Bradycardia
• B. Diarrhea
• C. Neutropenia
• D. Urinary retention

Correct answer: C

Rationale: The correct answer is C: Neutropenia. Paclitaxel commonly causes neutropenia due to bone marrow suppression. It is essential for clients receiving this medication to monitor for signs of neutropenia, such as fever, chills, and increased susceptibility to infections, as it can increase the risk of serious complications.

3. A client is receiving treatment with capecitabine. Which of the following findings should the nurse monitor?

• A. Hyperglycemia
• B. Hypocalcemia
• C. Neutropenia
• D. Bradycardia

Correct answer: C

Rationale: The nurse should monitor the client for neutropenia when receiving capecitabine, as it is a common adverse effect caused by bone marrow suppression. Neutropenia increases the risk of infection, making it essential for the nurse to closely monitor the client's white blood cell count and assess for signs of infection during treatment. Hyperglycemia (Choice A) is not typically associated with capecitabine. Hypocalcemia (Choice B) and bradycardia (Choice D) are not commonly linked to capecitabine use. Therefore, monitoring for neutropenia is the priority in this scenario.

4. A client has a new prescription for Valproic Acid. The client should be informed that which of the following laboratory tests need to be completed periodically? (Select all that apply.)

• A. Thrombocyte count.
• B. Hematocrit.
• C. Amylase.
• D. Liver function tests.

Correct answer: A

Rationale: Valproic acid can lead to thrombocytopenia, making it essential to monitor the client's thrombocyte count periodically. Additionally, valproic acid can cause pancreatitis, necessitating the monitoring of amylase levels. Furthermore, valproic acid carries a risk of hepatotoxicity, requiring regular monitoring of liver function tests.

5. Which drug undergoes extensive first-pass hepatic metabolism?

• A. Heparin
• B. Insulin
• C. Propranolol
• D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

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