Nursing Elites

1. A staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply.)

• A. Increased renal secretion
• B. Increased medication-metabolizing enzymes
• C. Liver failure
• D. Peripheral vascular disease

Correct answer: C

Rationale: Liver failure impairs metabolism, leading to increased medication concentrations. When liver function is compromised, lower dosages are necessary to prevent adverse effects. Increased renal secretion is not a reason for lower medication dosages, as it primarily affects excretion rather than metabolism. Increased medication-metabolizing enzymes would usually require higher dosages to achieve the desired effect. Peripheral vascular disease does not directly impact medication metabolism or dosage requirements.

2. A client has a new prescription for Ferrous sulfate. Which of the following instructions should the nurse include?

• A. Take this medication with milk.
• B. Take this medication on an empty stomach.
• C. Take this medication before bedtime.
• D. Take this medication with antacids.

Correct answer: B

Rationale: The correct answer is to take Ferrous sulfate on an empty stomach. This medication is best absorbed when taken 1 hour before or 2 hours after meals. Instructing the client to take it with milk, before bedtime, or with antacids can decrease its absorption and effectiveness. Taking it with milk can reduce the absorption of iron due to the calcium in milk. Taking it before bedtime is not necessary and may cause gastrointestinal upset. Taking it with antacids can interfere with the absorption of iron.

3. When teaching a patient to take their own pulse, which medication should the nurse instruct them to monitor? (Hint: if pulse is <60 or >100, the patient should contact their healthcare provider before taking the medication)

• A. Digoxin
• B. Lithium
• C. Montelukast
• D. Phenytoin

Correct answer: A

Rationale: It is essential for patients taking Digoxin to monitor their pulse regularly. If their pulse falls below 60 or exceeds 100 beats per minute, they should contact their healthcare provider immediately. This is crucial due to Digoxin's potential to affect heart rate, making pulse monitoring a vital aspect of patient care while on this medication.

4. A client with Subacute Bacterial Endocarditis is receiving Streptomycin IM among other antibiotics. For which of the following manifestations should the nurse monitor as an adverse effect of this medication?

• A. Extremity paresthesias
• B. Urinary retention
• C. Severe constipation
• D. Complex partial seizures

Correct answer: A

Rationale: The correct answer is extremity paresthesias. Streptomycin, used to treat infections like Subacute Bacterial Endocarditis, can cause paresthesias in the hands and feet as an adverse effect. Monitoring for this symptom is vital to detect and manage it promptly. Choices B, C, and D are incorrect because urinary retention, severe constipation, and complex partial seizures are not commonly associated adverse effects of Streptomycin.

5. A client has a new prescription for spironolactone. The client should avoid which of the following foods?

• A. Salt substitutes
• B. Apples
• C. Chicken
• D. Bananas

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic. Clients prescribed spironolactone should avoid salt substitutes because they often contain potassium. Increased potassium intake can lead to hyperkalemia, which is a potential side effect of spironolactone.

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