Nokea
A patient diagnosed with cancer is scheduled to receive vincristine. Which nursing assessment will have the highest priority when providing care for this patient?
- A. Degree of alopecia
- B. Increased digoxin levels
- C. Decreased phenytoin effects
- D. Peripheral neuropathy
Correct Answer: D
Rationale: Vincristine is known to cause peripheral neuropathy, a common and potentially debilitating side effect. The nurse should prioritize assessing for signs of neuropathy, such as tingling, numbness, or weakness in the extremities. Alopecia, while distressing, is not as critical as neuropathy, which can affect the patient's mobility and quality of life. Vincristine does not typically cause significant changes in digoxin or phenytoin levels, making these assessments less relevant. Early detection of neuropathy allows for dose adjustments or supportive interventions to minimize long-term damage.
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Which of the following has the shortest elimination half-life?
- A. Naloxone
- B. Morphine
- C. Methadone
- D. Remifentanil
Correct Answer: D
Rationale: Elimination half-life measures how quickly a drug is cleared from plasma. Naloxone's half-life is about 1-2 hours, used for opioid reversal. Morphine's is 2-4 hours, reflecting its duration as an analgesic. Methadone's is long, 15-60 hours, suiting addiction maintenance. Fentanyl's is 2-4 hours, typical for anesthesia. Remifentanil, an ultra-short-acting opioid, has a half-life of 3-10 minutes due to rapid esterase metabolism, making it ideal for procedures needing quick offset. Its brevity contrasts with others, ensuring minimal residual effects, a key advantage in critical care settings where rapid recovery is essential.
The newly licensed nurse is preparing to administer a high dose of androgen to the female client. The nurse manager asks for the rationale. What is the best response by the new nurse?
- A. My client wants to improve athletic performance
- B. My client has breast cancer
- C. My client has brain cancer
- D. My client is planning on sexual reassignment surgery
Correct Answer: B
Rationale: High-dose androgen therapy in females is occasionally used as a palliative treatment for certain breast cancers, particularly hormone-sensitive types, where it suppresses estrogen-driven tumor growth, offering symptom relief in advanced stages. Using androgens for athletic performance enhancement, while possible due to their anabolic effects, isn't a clinical indication and is illegal in regulated settings. Brain cancer lacks evidence supporting androgen use, as it doesn't target neurological malignancies. Sexual reassignment involves testosterone for masculinization, but high doses in a clinical context typically align with cancer care, not transition protocols. The breast cancer rationale reflects a recognized, albeit niche, therapeutic use, leveraging androgens' anti-estrogenic properties to slow disease progression, making it the most defensible clinical justification in this scenario.
A client has a new prescription for Atenolol. Which of the following statements should be included by the healthcare provider?
- A. Take the medication with a high-fat meal.
- B. Monitor your heart rate before taking the medication.
- C. Expect a persistent cough.
- D. Avoid foods high in fiber.
Correct Answer: B
Rationale: When a client is prescribed Atenolol, a beta-blocker, they should monitor their heart rate before taking the medication. It is crucial because if the heart rate is below 60 bpm, the client needs to contact their healthcare provider for further guidance and evaluation. Choices A, C, and D are incorrect. Atenolol does not need to be taken with a high-fat meal, does not typically cause a persistent cough, and there is no need to avoid foods high in fiber when taking this medication.
A nurse is completing discharge teaching for a client who has a new prescription for transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands the instructions?
- A. "I will clean the site with an alcohol swab before I apply the patch."
- B. "I will rotate the application sites weekly."
- C. "I will apply the patch to an area of skin with no hair."
- D. "I will place the new patch on the site of the old patch.
Correct Answer: B
Rationale: Rotating the application sites of transdermal patches is important to prevent skin irritation and enhance absorption efficiency. This practice helps to minimize skin irritation and allows the skin to recover between applications. By rotating the sites weekly, the client can ensure optimal medication delivery and reduce the risk of skin reactions at any specific application site. This indicates that the client understands the importance of proper patch placement and skin care.
A patient was admitted to the emergency department with a pulse oximeter reading of 85% after a successful prehospital resuscitation from cardiac arrest due to an asthma attack. What is the most important initial drug to administer as ordered?
- A. Epinephrine
- B. Sodium bicarbonate
- C. Albuterol
- D. Oxygen
Correct Answer: D
Rationale: Oxygen is the most important initial intervention for a patient with a low pulse oximeter reading (85%) to correct hypoxia and prevent further complications. While epinephrine (A) and albuterol (C) are used to treat asthma, oxygen is the priority to address the immediate hypoxia. Sodium bicarbonate (B) is not indicated unless there is severe metabolic acidosis.