Nursing Elites

1. What instructions should the practical nurse (PN) review with a client diagnosed with vaginal trichomoniasis who is prescribed oral metronidazole?

• A. Avoid direct sunlight exposure and use a sunscreen product with SPF100.
• B. The client's sexual partner(s) should also be treated.
• C. Avoid vinegar or commercial product douches.
• D. Eliminate dairy products from the diet during treatment.

Correct answer: B

Rationale: The correct answer is B. The practical nurse should instruct the client that their sexual partner(s) should also be treated when dealing with vaginal trichomoniasis. This is crucial to prevent reinfection as sexual intercourse is the route of spread for this infection. Choices A, C, and D are incorrect. While avoiding direct sunlight exposure and using sunscreen is important for some medications, it is not specifically related to metronidazole treatment for trichomoniasis. Avoiding vinegar or commercial douches is a general recommendation for vaginal health and not specific to this infection. Eliminating dairy products from the diet is not a typical instruction for clients prescribed metronidazole for vaginal trichomoniasis.

2. A client with a diagnosis of depression is prescribed fluoxetine. Which statement by the client indicates the need for further teaching?

• A. I should take this medication in the morning with food.
• B. It may take 1 to 4 weeks to notice improvement in symptoms.
• C. I can stop taking this medication once I feel better.
• D. This medication might make me feel drowsy.

Correct answer: C

Rationale: The correct answer is C. Clients prescribed fluoxetine should not stop taking the medication once they feel better without consulting their healthcare provider. It is essential to complete the full course of treatment as directed by the healthcare provider to prevent relapse or potential worsening of symptoms. Abruptly stopping fluoxetine can lead to withdrawal symptoms and may not effectively manage the condition. Therefore, it is crucial for clients to follow the healthcare provider's guidance regarding the duration of treatment with fluoxetine.

3. A client has been taking simvastatin for 3 days and calls the nurse at the clinic to report extreme muscle tenderness and pain. Which is the most appropriate action?

• A. Notify the health care provider.
• B. Review the medication with the client.
• C. Advise the client to avoid grapefruit juice.
• D. Remind the client to limit physical activity until evaluated by the health care provider.

Correct answer: A

Rationale: Extreme muscle tenderness and pain in a client taking simvastatin could indicate rhabdomyolysis, a serious condition. Promptly notifying the health care provider is crucial to evaluate and manage this potential medical emergency. Reviewing the medication with the client may not address the urgency of the situation. Advising the client to avoid grapefruit juice is not directly related to the client's current symptoms. Reminding the client to limit physical activity until evaluated by the health care provider is not appropriate as the client's symptoms should be assessed by a professional first.

4. When a client with hepatic encephalopathy is receiving lactulose, which parameter is essential to monitor for a response to the drug?

• A. Serum hepatic enzymes
• B. Fingerstick glucose
• C. Stool color and character
• D. Serum electrolytes and ammonia

Correct answer: D

Rationale: In hepatic encephalopathy, the goal of lactulose therapy is to reduce blood ammonia levels by promoting its excretion in the stool. Therefore, monitoring serum electrolytes and ammonia levels is crucial to assess the effectiveness of lactulose in lowering ammonia levels and improving the client's condition. Options A, B, and C are incorrect because serum hepatic enzymes, fingerstick glucose, and stool color/character are not directly related to monitoring the response to lactulose therapy in hepatic encephalopathy.

5. A client who is in the rehabilitation facility with newly diagnosed Parkinson's disease (PD) has levodopa-carbidopa prescribed. During the care planning session for this client, the nurse discusses which aspects with the other members of the health care team? (Select all that apply.)

• A. Ask the dietician to avoid increasing the amounts of foods high in Vitamin B6.
• B. Lessening of tremors
• C. Remind others on the team that this medication will not relieve all symptoms of PD.
• D. Ask the evening shift nurses to give the last dose earlier in the day if the client has insomnia.

Correct answer: D

Rationale: Levodopa-carbidopa is a medication commonly used in the treatment of Parkinson's disease (PD). It can cause side effects such as hypotension with sudden position changes. To assist the client in managing this side effect, the physical therapy assistant can help avoid sudden position changes. Additionally, if insomnia occurs, adjusting the timing of the last dose earlier in the day can be beneficial. It is important to note that drowsiness can also be a side effect of the medication and should be reported to the nurse. Foods high in Vitamin B6 can interfere with the absorption of levodopa-carbidopa; hence, it is advisable to avoid increasing the consumption of such foods. Lastly, it is crucial to remind the team that while this medication helps alleviate symptoms like tremors, it may not relieve all symptoms of PD comprehensively.

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