Nursing Elites

1. A client with a history of heart failure is prescribed carvedilol. The nurse should monitor for which potential side effect?

• A. Bradycardia
• B. Tachycardia
• C. Hypertension
• D. Hyperglycemia

Correct answer: A

Rationale: When a client is prescribed carvedilol, the nurse should monitor for bradycardia, a potential side effect of this medication. Carvedilol is a beta-blocker that can slow down the heart rate, so monitoring for signs of bradycardia is essential to prevent any adverse effects on the client's cardiovascular system. Tachycardia (Choice B) is less likely to occur with carvedilol since it primarily works to reduce heart rate. Hypertension (Choice C) and hyperglycemia (Choice D) are not common side effects associated with carvedilol.

2. 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.

3. An adolescent client with a seizure disorder is prescribed the anticonvulsant medication carbamazepine. The nurse should notify the healthcare provider if the client develops which condition?

• A. Experiences dry mouth.
• B. Experiences dizziness.
• C. Develops a sore throat.
• D. Develops gingival hyperplasia.

Correct answer: C

Rationale: The correct answer is C: 'Develops a sore throat.' When a client on carbamazepine develops flu-like symptoms such as pallor, fatigue, sore throat, and fever, it could indicate blood dyscrasias (aplastic anemia, leukopenia, anemia, thrombocytopenia), which are potential adverse effects of the medication. These symptoms warrant immediate notification of the healthcare provider for further evaluation and management to prevent complications. Choices A, B, and D are incorrect because dry mouth, dizziness, and gingival hyperplasia are not commonly associated with carbamazepine use and do not indicate serious adverse effects that require immediate healthcare provider notification.

4. A client vomits 30 minutes after receiving a dose of hydromorphone on the first postoperative day. What initial intervention is best for the practical nurse (PN) to implement?

• A. Obtain a prescription for nasogastric intubation.
• B. Administer a prn dose of ondansetron.
• C. Reduce the next scheduled dose of hydromorphone.
• D. Assess the client's abdomen and bowel sounds.

Correct answer: B

Rationale: In this scenario, the client's vomiting is likely due to the hydromorphone administration, indicating a need for an antiemetic such as ondansetron to address the nausea. Nasogastric intubation (Choice A) is not necessary at this point as the client is vomiting, not experiencing an obstruction. While reducing the dose of hydromorphone (Choice C) may be considered later, the immediate focus should be managing the client's symptoms. Assessing the client's abdomen and bowel sounds (Choice D) can be important but is not the initial priority when addressing the vomiting post hydromorphone administration.

5. What action should the nurse implement for a female client taking the bisphosphonate medication ibandronate for osteoporosis?

• A. Ask the client to describe how she takes the medication
• B. Reassure the client that the heartburn is temporary
• C. Explain that the use of antacids might be helpful
• D. Encourage the client to increase her calcium intake

Correct answer: A

Rationale: Ensuring correct administration of bisphosphonates, like ibandronate, is essential to maximize effectiveness and minimize potential side effects. By asking the client to describe how she takes the medication, the nurse can assess the client's understanding and adherence to the prescribed regimen, ultimately promoting optimal therapeutic outcomes.

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