Nursing Elites

1. A client with a diagnosis of schizophrenia is being treated with risperidone (Risperdal). Which side effect should the nurse monitor for?

• A. Hypertension
• B. Weight loss
• C. Hyperactivity
• D. Hyperglycemia

Correct answer: D

Rationale: The correct answer is D: Hyperglycemia. Risperidone (Risperdal) can lead to metabolic side effects, such as hyperglycemia, which requires monitoring. Choice A, Hypertension, is incorrect because risperidone is not typically associated with hypertension. Choice B, Weight loss, is less common with risperidone use as it can lead to weight gain. Choice C, Hyperactivity, is not a common side effect of risperidone; instead, it is more known for sedative effects.

2. A patient with asthma is prescribed a corticosteroid inhaler. What is the most important instruction to give to the patient?

• A. Use the inhaler only during asthma attacks.
• B. Rinse the mouth after using the inhaler.
• C. Take a double dose if symptoms worsen.
• D. Avoid using a spacer with the inhaler.

Correct answer: B

Rationale: The most important instruction to give to a patient using a corticosteroid inhaler is to rinse the mouth after each use. This is crucial to prevent the development of oral thrush, a common side effect of corticosteroid inhalers. Failure to rinse the mouth can lead to the overgrowth of yeast in the mouth, causing oral thrush, which can be uncomfortable and require additional treatment. Therefore, reminding patients to rinse their mouth after using the inhaler is essential in preventing this potential complication. Choices A, C, and D are incorrect. Using the inhaler only during asthma attacks may lead to uncontrolled asthma symptoms. Taking a double dose without healthcare provider instruction can result in overdose or side effects. Avoiding a spacer with the inhaler can reduce the effectiveness of delivering the medication to the lungs.

3. The healthcare provider is assessing a client with Cushing's syndrome. Which clinical manifestation should the healthcare provider expect to find?

• A. Hyperpigmentation of the skin.
• B. Hypotension.
• C. Moon face and buffalo hump.
• D. Weight loss.

Correct answer: C

Rationale: The correct answer is C: Moon face and buffalo hump. In Cushing's syndrome, excess production of corticosteroids leads to redistribution of fat, particularly in the face (moon face) and between the shoulders (buffalo hump). Hyperpigmentation of the skin is actually associated with Addison's disease, not Cushing's syndrome (choice A). Hypotension is not a typical finding in Cushing's syndrome; instead, hypertension is more commonly seen due to the effects of excess cortisol (choice B). Weight gain, rather than weight loss, is a common symptom of Cushing's syndrome due to the metabolic disturbances caused by excess cortisol (choice D).

4. Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?

• A. Continue taking warfarin until the day of surgery.
• B. Stop taking warfarin three days before surgery.
• C. Switch to aspirin before surgery.
• D. Stop taking warfarin one week before surgery.

Correct answer: D

Rationale: Prior to elective surgery, a patient taking warfarin should be instructed to stop taking warfarin around one week before the procedure. This timeframe allows for the effects of warfarin to diminish, lowering the risk of excessive bleeding during surgery. Continuing warfarin until the day of surgery (Choice A) increases the risk of bleeding complications. Stopping warfarin three days before surgery (Choice B) may not provide enough time for the anticoagulant effects to subside. Switching to aspirin before surgery (Choice C) is not recommended as a substitute for warfarin in this context.

5. What instruction should a patient with a history of hypertension be provided when being discharged with a prescription for a thiazide diuretic?

• A. Avoid foods high in potassium.
• B. Take the medication at bedtime.
• C. Monitor weight daily.
• D. Limit fluid intake to 1 liter per day.

Correct answer: C

Rationale: The correct instruction for a patient with a history of hypertension being discharged with a prescription for a thiazide diuretic is to monitor weight daily. This is important because thiazide diuretics can cause fluid imbalances, and monitoring weight daily can help detect significant changes early. Choice A, avoiding foods high in potassium, is not directly related to thiazide diuretics. Choice B, taking the medication at bedtime, may vary depending on the specific medication but is not a universal instruction. Choice D, limiting fluid intake to 1 liter per day, is not appropriate as adequate hydration is important to prevent complications like hypokalemia.

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