Nursing Elites

1. A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request?

• A. Determine if a take-home prescription for hydrocodone was provided and, if so, tell him to take one of them.
• B. Encourage him to wait until he is at home to take a medication that might impair reasoning.
• C. Give him a tablet from the hospital stock and tell him to wait until he is almost home to take it.
• D. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10.

Correct answer: D

Rationale: Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.

2. The practical nurse is assigned a client on digoxin therapy. Which finding is likely to predispose this client to developing digoxin toxicity?

• A. Hyponatremia
• B. Hypernatremia
• C. Hyperkalemia
• D. Hypokalemia

Correct answer: D

Rationale: Hypokalemia predisposes a client on digoxin to digoxin toxicity. Symptoms of digoxin toxicity include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Therefore, assessment of serum potassium levels and prompt correction of hypokalemia are crucial interventions for clients taking digoxin.

3. A client with a history of atrial fibrillation is prescribed diltiazem. The nurse should monitor for which potential side effect?

• A. Hypotension
• B. Tachycardia
• C. Headache
• D. Hyperglycemia

Correct answer: A

Rationale: The correct answer is A: Hypotension. Diltiazem is a calcium channel blocker that can cause hypotension by relaxing blood vessels and reducing blood pressure. Monitoring blood pressure is essential to detect and manage this potential side effect. Choices B, C, and D are incorrect because diltiazem typically does not cause tachycardia, headache, or hyperglycemia as common side effects.

4. When a client with a history of deep vein thrombosis is prescribed fondaparinux, the nurse should monitor for which potential adverse effect?

• A. Increased risk of bleeding
• B. Decreased risk of bleeding
• C. Increased risk of infection
• D. Decreased risk of infection

Correct answer: A

Rationale: Fondaparinux is an anticoagulant prescribed to prevent blood clots. Therefore, the nurse should monitor the client for an increased risk of bleeding, which is a potential adverse effect of this medication. Choices B, C, and D are incorrect because fondaparinux does not decrease the risk of bleeding, increase the risk of infection, or decrease the risk of infection. Monitoring for signs of bleeding, such as unexplained bruising, bleeding gums, or blood in the urine or stool, is crucial when a client is on fondaparinux.

5. A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. What action should the nurse take?

• A. Explain that the medication may take time to show improvement in symptoms
• B. Withhold the medication and notify the healthcare provider
• C. Advise the client to undergo liver function tests
• D. Document the assessment findings in the electronic health record

Correct answer: D

Rationale: In this scenario, the nurse's priority is to document the assessment findings in the electronic health record. This action is crucial for maintaining an accurate record of the client's health status and can provide valuable information for the healthcare team. While it is important to monitor the client's response to riluzole, explaining that the medication may take time to show improvement (Choice A) would be more appropriate if the client was expecting immediate results. Withholding the medication and notifying the healthcare provider (Choice B) should not be the initial action without further assessment or guidance. Advising the client to undergo liver function tests (Choice C) is not directly related to the current situation of weakness and muscle atrophy.

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