Nursing Elites

1. A client who takes metformin for diabetes mellitus type 2 is nothing by mouth (NPO) for surgery. What pre-op prescription should the practical nurse (PN) anticipate for this client's glucose management?

• A. NPO except for metformin and regular snacks
• B. NPO except for oral antidiabetic agent
• C. Novolin-N insulin subcutaneously twice daily
• D. Regular insulin subcutaneously per sliding scale

Correct answer: D

Rationale: When a client taking metformin for diabetes mellitus type 2 is NPO for surgery, it is crucial to manage their glucose levels effectively. The best approach in this situation is to prescribe regular insulin subcutaneously according to a sliding scale based on the client's blood glucose levels. This method allows for precise adjustment of insulin doses to maintain blood glucose within the target range while the client is unable to take oral medications. Choices A and B are incorrect because metformin is typically held when a client is NPO, and oral antidiabetic agents may not provide sufficient glucose control. Choice C is incorrect as Novolin-N insulin given twice daily may not offer the flexibility needed for glucose management in a surgical setting where the client's intake is restricted.

2. What instruction should the nurse include in the teaching plan for a client prescribed ranitidine for a peptic ulcer?

• A. Take this medication in the morning before breakfast.
• B. Take this medication with meals.
• C. Avoid taking this medication with antacids.
• D. Take this medication at bedtime.

Correct answer: A

Rationale: The correct instruction for a client prescribed ranitidine for a peptic ulcer is to take the medication in the morning before breakfast. This timing helps reduce stomach acid production throughout the day, providing optimal therapeutic effects. Option B is incorrect because taking ranitidine with meals is not the recommended timing. Option C is incorrect as there is no specific contraindication against taking ranitidine with antacids. Option D is incorrect as the medication should not be taken at bedtime but rather in the morning before breakfast.

3. 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.

4. A client has sublingual nitroglycerine tablets prescribed to treat angina. The nurse realizes the client requires further education if the client makes which statements? (Select one that doesn't apply.)

• A. I will need to replace the nitroglycerine tablets every 3 to 5 months, not in a year.
• B. I should continue taking nitroglycerine tablets if I develop a headache.
• C. I understand nitroglycerine tablets do not cause addiction.
• D. If I feel dizzy when I take these, I should sit down or lie down until I feel better.

Correct answer: D

Rationale: The correct answer is D. Nitroglycerine sublingual tablets need to be replaced every 3 to 5 months, not every year, making statement A incorrect. While nitroglycerine can cause a headache, it is important to continue taking the prescribed nitroglycerine if the client has angina, making statement B accurate. Nitroglycerine tablets do not cause addiction, so statement C is correct. Dizziness and weakness are associated with the hypotensive effect of nitroglycerine; therefore, if the client feels dizzy when taking them, they should sit down or lie down until they feel better. Taking nitroglycerine tablets before an activity known to cause angina can help prevent angina attacks.

5. A client with diabetes mellitus type 2 is prescribed sitagliptin. The nurse should include which instruction in the client's teaching plan?

• A. Take this medication with meals.
• B. Avoid alcohol while taking this medication.
• C. Take this medication on an empty stomach.
• D. Report any signs of pancreatitis to the healthcare provider.

Correct answer: D

Rationale: The correct instruction to include in the teaching plan for a client prescribed sitagliptin is to report any signs of pancreatitis to the healthcare provider. Sitagliptin is generally taken with meals to reduce gastrointestinal side effects. Therefore, choice A, 'Take this medication with meals,' is incorrect. Sitagliptin does not have specific interactions with alcohol, so there is no need to advise the client to avoid alcohol, making choice B incorrect. Taking sitagliptin on an empty stomach is not recommended, so choice C is also incorrect. Pancreatitis is a rare but serious side effect of sitagliptin, so it is crucial for the client to report any signs or symptoms to their healthcare provider promptly.

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