Nursing Elites

1. A client with asthma is receiving long-term glucocorticoid therapy. The nurse includes a risk for impaired skin integrity on the client's problem list. What is the rationale for including this problem?

• A. Abnormal fat deposits impair circulation
• B. Frequent diarrhea can lead to skin issues
• C. Thinned skin bruises easily
• D. Decreased serum glucose prolongs healing time

Correct answer: C

Rationale: The correct answer is C. Glucocorticoids can cause skin thinning, which increases the likelihood of bruising. Thinning of the skin due to glucocorticoid therapy makes it more fragile and prone to injury, such as bruising, even with minimal trauma. Choices A, B, and D are incorrect because abnormal fat deposits impairing circulation, frequent diarrhea causing skin issues, and decreased serum glucose prolonging healing time are not direct effects of glucocorticoid therapy on skin integrity.

2. 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.

3. Prior to administering an oral dose of methylprednisolone, what is most important for the nurse to do?

• A. Administer the medication with a glass of milk
• B. Notify the healthcare provider of the finding
• C. Begin tapering the drug dose per protocol
• D. Teach the clients about foods high in calcium

Correct answer: A

Rationale: Administering methylprednisolone with food or milk is important as it can help reduce gastrointestinal side effects associated with the medication. This practice is commonly recommended to minimize stomach upset and irritation that may occur when taking methylprednisolone on an empty stomach. Therefore, it is crucial for the nurse to provide the medication with a glass of milk to enhance patient comfort and adherence to the treatment regimen. Choice B is incorrect as there is no indication in the question stem that suggests a need to notify the healthcare provider before administering the medication with food or milk. Choice C is incorrect because tapering the drug dose per protocol is not the immediate action needed prior to administering the first dose of methylprednisolone. Choice D is irrelevant to the administration of methylprednisolone and not the most important action to take before giving the medication.

4. A client admitted with shortness of breath and palpitations currently takes an antiarrhythmic medication, dronedarone. Which action should the nurse take to prevent arrhythmias?

• A. Measure orthostatic blood pressure
• B. Obtain a 12-lead ECG reading daily
• C. Assess the client's apical pulse daily
• D. Provide continuous ECG monitoring

Correct answer: D

Rationale: The correct action to prevent arrhythmias in a client taking an antiarrhythmic medication like dronedarone is to provide continuous ECG monitoring. This is essential because antiarrhythmic drugs can sometimes cause pro-arrhythmic effects, which may lead to dangerous heart rhythm disturbances. Continuous ECG monitoring allows for real-time detection of any abnormal rhythms, enabling prompt intervention. Measuring orthostatic blood pressure, obtaining a 12-lead ECG reading daily, and assessing the client's apical pulse daily are important assessments in general patient care but may not specifically prevent arrhythmias in this scenario.

5. A client is prescribed an antibiotic for a urinary tract infection (UTI). What instruction should the practical nurse provide to the client to ensure the effectiveness of the medication?

• A. Take the medication with food.
• B. Increase fluid intake.
• C. Complete the full course of the medication.
• D. Avoid dairy products.

Correct answer: C

Rationale: The practical nurse should instruct the client to complete the full course of the antibiotic to ensure the infection is fully treated and to prevent the development of antibiotic resistance. Completing the full course of antibiotics helps to eradicate the infection completely and reduces the risk of bacteria developing resistance to the medication. Choices A, B, and D are not directly related to ensuring the effectiveness of the antibiotic. While taking medication with food or increasing fluid intake can be beneficial in general, the crucial instruction in this case is to complete the full course of the antibiotic.

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