Nursing Elites

1. A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

• A. Two to three soft bowel movements daily
• B. Significant increase in appetite and food intake
• C. Absence of nausea and vomiting
• D. Absence of blood or mucus in stool

Correct answer: A

Rationale: Lactulose is used in hepatic encephalopathy to reduce blood ammonia levels by promoting bowel movements. The desired outcome of lactulose therapy is typically two to three soft bowel movements daily, which helps in eliminating excess ammonia from the body, thus improving the client's condition.

2. An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer?

• A. Corticosteroids
• B. Gamma globulin
• C. Hepatitis B vaccine
• D. Fresh frozen plasma

Correct answer: B

Rationale: In this scenario, the immediate need is to provide passive immunity to the adolescent patient. Gamma globulin contains antibodies against hepatitis B, which can offer immediate protection. The hepatitis B vaccine provides active immunity over time but is not immediate. Fresh frozen plasma and corticosteroids are not indicated for immediate protection against hepatitis B infection. Therefore, the correct choice is Gamma globulin as it can provide immediate passive immunity against hepatitis B.

3. A client with heart failure is prescribed digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse teach the client to report?

• A. Increased appetite.
• B. Yellow or blurred vision.
• C. Weight gain.
• D. Nasal congestion.

Correct answer: B

Rationale: Yellow or blurred vision is a hallmark sign of digoxin toxicity. Digoxin toxicity can affect various body systems, but visual disturbances, such as yellow or blurred vision, are important signs that the client should report immediately. Other signs like increased appetite, weight gain, or nasal congestion are not typically associated with digoxin toxicity. Prompt reporting of visual disturbances can help prevent further complications associated with digoxin toxicity.

4. A client who has been receiving treatment for depression with a selective serotonin reuptake inhibitor (SSRI) reports experiencing decreased libido. What is the best response by the nurse?

• A. Decreased libido is a common side effect of SSRIs and may improve over time.
• B. I will notify your healthcare provider to discuss possible medication changes.
• C. You should take your medication with food to reduce side effects.
• D. Increase your daily exercise to help manage this side effect.

Correct answer: B

Rationale: When a client reports experiencing decreased libido while taking SSRIs, it is important for the nurse to notify the healthcare provider to discuss potential medication adjustments. This side effect can significantly impact a client's quality of life, and addressing it promptly by involving the healthcare provider is crucial in providing holistic care. Choices A, C, and D do not directly address the issue of decreased libido caused by SSRIs. Simply waiting for improvement over time, altering the administration of medication with food, or increasing exercise are not appropriate strategies for managing this specific side effect.

5. For a patient with asthma, what is the primary purpose of prescribing montelukast?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Thin respiratory secretions
• D. Suppress cough

Correct answer: B

Rationale: Montelukast, a leukotriene receptor antagonist, is primarily prescribed to prevent asthma attacks. It works by reducing inflammation and bronchoconstriction in the airways, thereby helping to control asthma symptoms and prevent exacerbations.

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