Nursing Elites

1. A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication?

• A. Nausea
• B. Diarrhea
• C. Anorexia
• D. Cough and chest pain

Correct answer: D

Rationale: Pulmonary reactions such as cough and chest pain are serious side effects associated with nitrofurantoin that require immediate discontinuation of the medication to prevent potential severe respiratory complications.

2. A client is prescribed calcium gluconate after thyroidectomy. The medication is most likely prescribed to:

• A. Treat thyroid storm.
• B. Prevent cardiac irritability.
• C. Treat hypocalcemic tetany.
• D. Stimulate the release of parathyroid hormone.

Correct answer: C

Rationale: After a thyroidectomy, the parathyroid glands can be inadvertently removed or damaged, leading to a decrease in calcium levels and potentially causing hypocalcemic tetany. Calcium gluconate is given to supplement calcium levels and prevent or treat hypocalcemia-related symptoms, such as muscle spasms and tetany.

3. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:

• A. Immediately before swimming
• B. 15 minutes before exposure to the sun
• C. Immediately before exposure to the sun
• D. At least 30 minutes before exposure to the sun

Correct answer: D

Rationale: Chemical sunscreens are most effective when applied at least 30 minutes before exposure to the sun to allow them to penetrate the skin and provide optimal protection. Applying sunscreen immediately before swimming (Choice A) or immediately before exposure to the sun (Choice C) may not provide sufficient time for the sunscreen to be absorbed and offer proper protection. Applying sunscreen 15 minutes before sun exposure (Choice B) is also not ideal as it may not allow enough time for the sunscreen to work effectively. Therefore, the correct answer is to apply chemical sunscreen at least 30 minutes before exposure to the sun to ensure it can be absorbed and offer the intended protection. It is important to reapply sunscreen after swimming or sweating to maintain its effectiveness.

4. A client is receiving vancomycin (Vancocin). Which of the following is the most important action for the nurse to take?

• A. Monitor the client for signs of nephrotoxicity.
• B. Monitor the client for signs of ototoxicity.
• C. Ensure adequate hydration.
• D. Administer the medication with food.

Correct answer: A

Rationale: The most important action for the nurse to take when a client is receiving vancomycin is to monitor for signs of nephrotoxicity. Vancomycin can cause kidney damage, so monitoring kidney function and signs of nephrotoxicity are crucial to prevent harm. While monitoring for ototoxicity and ensuring adequate hydration are important nursing actions, they are not as critical as preventing nephrotoxicity when administering vancomycin.

5. In a client with chronic renal failure receiving epoetin alfa (Epogen, Procrit), which laboratory result would indicate a therapeutic effect of the medication?

• A. Hematocrit of 32%
• B. Platelet count of 400,000 cells/mm³
• C. White blood cell count of 6000 cells/mm³
• D. Blood urea nitrogen (BUN) level of 15 mg/dL

Correct answer: A

Rationale: A hematocrit of 32% indicates a therapeutic effect of epoetin alfa in a client with chronic renal failure. Epoetin alfa is used to treat anemia in these patients by stimulating red blood cell production, leading to an increase in the hematocrit level. Monitoring the hematocrit is essential to assess the response to epoetin alfa therapy.

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