Nursing Elites

1. A client in an acute care facility is receiving IV Nitroprusside for hypertensive crisis. The nurse should monitor the client for which of the following adverse reactions to this medication?

• A. Intestinal ileus
• B. Neutropenia
• C. Delirium
• D. Hyperthermia

Correct answer: C

Rationale: The correct answer is C: Delirium. When IV nitroprusside is administered at high dosages, it can lead to thiocyanate toxicity, resulting in mental status changes such as delirium. Monitoring thiocyanate levels during therapy is crucial to ensure they remain below 10 mg/dL to prevent this adverse reaction. Choices A, B, and D are incorrect because nitroprusside does not typically cause intestinal ileus, neutropenia, or hyperthermia as adverse reactions.

2. A child is prescribed Amoxicillin 20 mg/kg/day PO to be administered every 12 hr. The child weighs 44 lb. The available medication is amoxicillin suspension 250 mg/5 mL. How many mL should be given per dose?

• A. 4 mL
• B. 5 mL
• C. 6 mL
• D. 3 mL

Correct answer: A

Rationale: To calculate the dosage per administration: Convert the weight to kg (44 lb / 2.2 lb/kg = 20 kg). Then, (20 mg/kg/day x 20 kg) / 2 (for every 12 hr dosing) = 200 mg per dose. (200 mg / 250 mg) x 5 mL = 4 mL per dose. Therefore, the nurse should administer 4 mL of amoxicillin suspension per dose. Choice B, 5 mL, is incorrect because the calculation shows that 4 mL is the correct dose. Choices C and D are also incorrect as they are not in line with the calculated dosage based on the weight of the child and the concentration of the medication.

3. A client has a new prescription for Alteplase. Which of the following actions should the nurse plan to take?

• A. Administer the medication within 4 hours of the onset of symptoms.
• B. Reconstitute the medication with sterile saline.
• C. Administer heparin concurrently with the Alteplase infusion.
• D. Monitor for changes in level of consciousness.

Correct answer: D

Rationale: Alteplase is a thrombolytic agent used to dissolve blood clots. Patients receiving Alteplase are at risk for bleeding complications, including intracranial bleeding. Monitoring for changes in the level of consciousness is crucial as it can indicate early signs of bleeding, such as increased intracranial pressure. This rapid assessment allows for timely intervention and prevention of further complications. Choices A, B, and C are incorrect. Administering Alteplase within 4 hours of symptom onset is related to the time-sensitive nature of thrombolytic therapy for conditions like acute myocardial infarction or ischemic stroke. Reconstituting Alteplase with sterile saline is a correct step in preparing the medication for administration. Administering heparin concurrently with Alteplase is generally avoided due to the increased risk of bleeding.

4. While teaching a client with a new prescription for Warfarin, which of the following statements by the client indicates a need for further teaching?

• A. I will avoid eating large amounts of green leafy vegetables.
• B. I will take my medication at the same time every day.
• C. I will increase my intake of foods high in potassium.
• D. I will report any signs of bleeding to my provider.

Correct answer: C

Rationale: The correct answer is C because Warfarin interacts with vitamin K, found in green leafy vegetables, not potassium. The client should avoid consuming large amounts of foods high in vitamin K to maintain the effectiveness of Warfarin therapy. Increasing potassium intake is not a concern related to Warfarin therapy, so this statement indicates a need for further teaching. Choices A, B, and D are all correct statements indicating good understanding of Warfarin therapy. Avoiding large amounts of green leafy vegetables helps prevent fluctuations in vitamin K levels, taking medication consistently maintains therapeutic levels, and reporting any signs of bleeding is essential for monitoring and managing potential side effects of Warfarin.

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

• A. Monitor for signs of bleeding.
• B. Avoid taking the medication with food.
• C. Expect to have increased urination.
• D. Take the medication with an antacid.

Correct answer: A

Rationale: Corrected Rationale: Clopidogrel is an antiplatelet medication that increases the risk of bleeding. The client should monitor for any signs of bleeding, such as easy bruising, prolonged bleeding from cuts, blood in urine or stool, and report them promptly to their healthcare provider for further evaluation and management. Choice B is incorrect because Clopidogrel can be taken with or without food. Choice C is incorrect as increased urination is not a common side effect of Clopidogrel. Choice D is incorrect as taking Clopidogrel with an antacid may reduce its effectiveness.

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