Nursing Elites

1. A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

• A. Dilute the available heparin in 250ml of normal saline solution prior to IV administration
• B. Advise the pharmacy on the need to deliver a vial of heparin to the nursing unit immediately
• C. Calculate and administer the equivalent dose of the available low molecular weight heparin
• D. Request a prescription to change the route of administration and use the available heparin

Correct answer: B

Rationale: In this scenario, the nurse should contact the pharmacy to obtain the correct heparin formulation as the prescription calls for heparin 1,000 units IV STAT. Low molecular weight heparin is not the same as unfractionated heparin, and therefore, the nurse should not administer the available low molecular weight heparin without first obtaining the correct medication. Diluting the available heparin, calculating an equivalent dose, or changing the route of administration would not address the discrepancy between the prescribed heparin and the available low molecular weight heparin.

2. A client arrives at the emergency department experiencing diabetic ketoacidosis (DKA). The healthcare provider prescribes an insulin intravenous drip. Which type of insulin should the nurse locate for the registered nurse to mix into the intravenous fluids?

• A. Isophane
• B. Glargine
• C. Regular
• D. Detemir

Correct answer: C

Rationale: The correct insulin type for the nurse to mix into the intravenous fluids is regular insulin. In the scenario of diabetic ketoacidosis (DKA), rapid reduction of blood glucose levels is crucial. Regular insulin has a fast onset of action, making it suitable for intravenous administration to address the high blood sugar levels seen in DKA. Isophane, Glargine, and Detemir are not appropriate choices for intravenous administration in this emergency situation as they are intermediate-acting or long-acting insulins which do not provide the rapid response needed in DKA.

3. A client with schizophrenia is prescribed risperidone. Which statement by the client indicates the need for further teaching?

• A. I can stop taking this medication once I feel better.
• B. This medication may cause drowsiness.
• C. This medication might make me feel drowsy.
• D. I should avoid alcohol while taking this medication.

Correct answer: A

Rationale: Clients should not stop taking risperidone abruptly once they feel better without consulting their healthcare provider.

4. A client taking long-term steroids also has ranitidine prescribed. The nurse provides which explanation as to why these drugs are given together?

• A. Ranitidine reduces the risk of ulcers associated with steroids.
• B. Ranitidine decreases the risk of infection associated with steroids.
• C. Ranitidine decreases blood sugar elevations associated with steroids.
• D. Ranitidine reduces sodium retention associated with steroid usage.

Correct answer: A

Rationale: The correct answer is A. Ranitidine is prescribed with long-term steroids to reduce the risk of ulcers associated with steroid therapy. Although steroids can increase the risk of ulcers due to their effect on the gastrointestinal system, ranitidine works by reducing stomach acid production, thus helping to prevent ulcer formation. Choices B, C, and D are incorrect as ranitidine is not given to decrease the risk of infection, reduce blood sugar elevations, or reduce sodium retention associated with steroid usage.

5. A client with asthma is receiving long-term glucocorticoid therapy. The nurse includes a risk for impaired skin integrity on the client's problem list. What is the rationale for including this problem?

• A. Abnormal fat deposits impair circulation
• B. Frequent diarrhea can lead to skin issues
• C. Thinned skin bruises easily
• D. Decreased serum glucose prolongs healing time

Correct answer: C

Rationale: The correct answer is C. Glucocorticoids can cause skin thinning, which increases the likelihood of bruising. Thinning of the skin due to glucocorticoid therapy makes it more fragile and prone to injury, such as bruising, even with minimal trauma. Choices A, B, and D are incorrect because abnormal fat deposits impairing circulation, frequent diarrhea causing skin issues, and decreased serum glucose prolonging healing time are not direct effects of glucocorticoid therapy on skin integrity.

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