Nursing Elites

1. A client with Addison's disease becomes confused and weak. What is the nurse's first action?

• A. Administer a dose of hydrocortisone immediately.
• B. Check the client’s electrolyte levels.
• C. Administer a dose of normal saline.
• D. Measure the client’s blood pressure in both arms.

Correct answer: A

Rationale: The correct answer is to administer a dose of hydrocortisone immediately. In Addison's disease, confusion and weakness can be signs of an adrenal crisis. Administering hydrocortisone promptly is crucial to prevent further deterioration. Checking electrolyte levels (Choice B) is important but not the first action in managing an acute adrenal crisis. Administering normal saline (Choice C) is not the priority in this situation. Measuring blood pressure in both arms (Choice D) is not the initial action needed to address the client's confusion and weakness in Addison's disease.

2. A client with rheumatoid arthritis has just been prescribed methotrexate. What teaching should the nurse include?

• A. Take the medication on an empty stomach.
• B. Report any signs of infection, such as a sore throat.
• C. Take folic acid supplements to prevent anemia.
• D. Use sunscreen to prevent photosensitivity.

Correct answer: D

Rationale: The correct answer is D: 'Use sunscreen to prevent photosensitivity.' Methotrexate increases photosensitivity, so clients should be advised to use sunscreen to protect their skin from sun exposure. Choice A is incorrect because methotrexate is usually taken with food to reduce gastrointestinal side effects. Choice B may be important but is not specific to methotrexate therapy. Choice C is also important, but the primary reason for folic acid supplementation with methotrexate is to reduce the risk of certain side effects like anemia rather than preventing anemia itself.

3. The client is being taught about precautions with Coumadin therapy. The client should be instructed to avoid which over-the-counter medication?

• A. Non-steroidal anti-inflammatory drugs
• B. Cough medicines containing guaifenesin
• C. Histamine blockers
• D. Laxatives containing magnesium salts

Correct answer: A

Rationale: The correct answer is A: Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can increase the risk of bleeding in clients taking Coumadin, which is an anticoagulant medication. Avoiding NSAIDs helps prevent potentially dangerous interactions with Coumadin. Choices B, C, and D are incorrect. Cough medicines with guaifenesin, histamine blockers, and laxatives containing magnesium salts do not typically have significant interactions with Coumadin therapy. Therefore, they are not the over-the-counter medications that the client needs to avoid while on Coumadin.

4. A client is receiving a blood transfusion and develops chills and back pain. What is the nurse's first action?

• A. Stop the transfusion and notify the healthcare provider.
• B. Monitor the client's vital signs every 15 minutes.
• C. Administer a PRN dose of diphenhydramine.
• D. Prepare to administer an antihistamine.

Correct answer: A

Rationale: The correct first action for the nurse is to stop the transfusion and notify the healthcare provider. These symptoms suggest a transfusion reaction, and stopping the transfusion is crucial to prevent further complications. Notifying the healthcare provider ensures timely intervention and appropriate management for the client's condition. Monitoring vital signs, administering diphenhydramine, or preparing to administer an antihistamine can be considered after stopping the transfusion and seeking guidance from the healthcare provider. However, the immediate priority is to halt the transfusion and inform the provider.

5. The healthcare provider is caring for a client with severe anemia. Which assessment finding requires immediate intervention?

• A. Pale skin
• B. Increased heart rate
• C. Shortness of breath
• D. Fatigue

Correct answer: C

Rationale: Shortness of breath is a critical sign in severe anemia as it indicates inadequate oxygenation, which can be life-threatening. Immediate intervention is necessary to address this condition. Pale skin (choice A) is a common finding in anemia but not as urgent as shortness of breath. Increased heart rate (choice B) is a compensatory mechanism in anemia to maintain oxygen delivery and is important but not as urgent as addressing inadequate oxygenation. Fatigue (choice D) is a common symptom in anemia but does not indicate an immediate life-threatening situation like shortness of breath does.

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