Nursing Elites

1. A client has a new prescription for Spironolactone. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia due to its mechanism of action. Hyperkalemia can cause muscle weakness and cardiac dysrhythmias. Therefore, the nurse should educate the client to monitor for signs and symptoms of hyperkalemia while taking Spironolactone.

2. When educating a client prescribed Rifampin, which instruction should the nurse provide?

• A. Expect orange discoloration of urine.
• B. Take the medication with food.
• C. Increase your intake of dairy products.
• D. Discontinue the medication if you experience itching.

Correct answer: A

Rationale: The correct instruction for a client prescribed Rifampin is to expect orange discoloration of urine. Rifampin is known to cause harmless discoloration of bodily fluids, including urine, which is a common side effect of this medication. It is important for the nurse to educate the client about this expected side effect to prevent unnecessary concern or discontinuation of the medication. Choices B, C, and D are incorrect because Rifampin does not require specific dietary considerations like taking it with food or increasing dairy intake. Furthermore, itching is not a common side effect that would necessitate immediate discontinuation of Rifampin.

3. A client has a new prescription for Sulfasalazine for the treatment of Crohn's disease. Which of the following instructions should the nurse include?

• A. Expect orange-yellow discoloration of urine and skin.
• B. Take the medication with food.
• C. Do not discontinue the medication if a sore throat occurs.
• D. Avoid prolonged exposure to sunlight.

Correct answer: A

Rationale: The correct answer is A: 'Expect orange-yellow discoloration of urine and skin.' Sulfasalazine can cause this harmless side effect, which does not require discontinuation of the medication. Option B is incorrect because Sulfasalazine is usually taken with food to minimize gastrointestinal side effects. Option C is incorrect as a sore throat is not a common reason to stop the medication. Option D is not directly related to the side effects of Sulfasalazine.

4. A client is prescribed Digoxin. Which of the following findings should the nurse monitor as a sign of potential toxicity?

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

Correct answer: A

Rationale: Corrected Rationale: Bradycardia is a common sign of Digoxin toxicity. Digoxin, a medication used to treat heart conditions, can lead to toxicity manifesting as bradycardia. Monitoring the client's heart rate closely is crucial to detect potential toxicity early and prevent complications. Hypertension, hyperglycemia, and hypocalcemia are not typically associated with Digoxin toxicity. Therefore, options B, C, and D are incorrect.

5. A client is to receive Tetracaine before a Bronchoscopy. Which of the following actions should the nurse include in the plan of care?

• A. Keep the client NPO until the pharyngeal response returns.
• B. Monitor the insertion site for a hematoma.
• C. Palpate the bladder to detect urinary retention.
• D. Maintain the client on bed rest for 12 hours following the procedure.

Correct answer: A

Rationale: The correct action for the nurse to include in the plan of care is to keep the client NPO until the pharyngeal response returns. Tetracaine can affect the gag reflex, so it is important to prevent aspiration by maintaining the client NPO until the pharyngeal response is normal, which typically takes about 1 hour. Monitoring for the return of the gag reflex is crucial to prevent complications from aspiration during the first oral intake after the procedure. Choices B, C, and D are incorrect because they are not directly related to the effects of Tetracaine or the bronchoscopy procedure.

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