Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium. The nurse should instruct the client to report which potential side effect?

• A. Dry mouth
• B. Blurred vision
• C. Nausea
• D. Tachycardia

Correct answer: A

Rationale: The correct answer is A: Dry mouth. Tiotropium, a commonly prescribed medication for COPD, can cause dry mouth as a side effect. While it may not be severe, clients should report it if it becomes bothersome. Dry mouth is a common side effect of tiotropium due to its anticholinergic properties. Blurred vision, nausea, and tachycardia are not typically associated with tiotropium use in the context of COPD.

2. A client with severe rheumatoid arthritis is prescribed infliximab. The nurse should monitor for which potential adverse effect?

• A. Increased risk of infection
• B. Bone marrow suppression
• C. Hair loss
• D. Pancreatitis

Correct answer: A

Rationale: The correct answer is A: Increased risk of infection. Infliximab is known to increase the risk of infection due to its immunosuppressive effects. It is crucial for the nurse to monitor for signs of infection in the client receiving infliximab to promptly address any potential complications and ensure the client's safety and well-being. Choices B, C, and D are incorrect because bone marrow suppression, hair loss, and pancreatitis are not typically associated with infliximab therapy. While these adverse effects can occur with other medications, the primary concern with infliximab is the increased risk of infection.

3. The healthcare professional is preparing client teaching materials on commonly used medications. Which client is most likely to benefit from a client education package about simvastatin?

• A. A 50-year-old male with a history of angina
• B. A 75-year-old male with bone cancer
• C. An 18-year-old pregnant female with diabetes
• D. A 40-year-old female with frequent vaginal infections

Correct answer: A

Rationale: Simvastatin is a medication used to lower cholesterol levels and prevent cardiovascular diseases. It is commonly prescribed for individuals at risk of heart-related conditions. Angina is a symptom of underlying heart disease, and individuals with this condition would benefit most from simvastatin to help manage their cholesterol levels and reduce the risk of cardiovascular events. Therefore, the 50-year-old male with a history of angina is the most suitable candidate for client education regarding simvastatin. Choices B, C, and D are not the most appropriate candidates for simvastatin education because bone cancer, pregnancy with diabetes, and frequent vaginal infections are not conditions typically treated with simvastatin.

4. 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.

5. A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?

• A. The client is experiencing vision and hearing loss.
• B. The client has an erection lasting longer than 4 hours.
• C. The client is complaining of nasal congestion.
• D. The client is complaining of feeling flushed.

Correct answer: A

Rationale: The correct answer is A. If a client prescribed sildenafil for pulmonary hypertension experiences vision and/or hearing loss or an erection lasting more than 4 hours, the practical nurse should instruct the client to discontinue the medication immediately and notify the health care provider. These symptoms could indicate serious side effects that require prompt medical attention to prevent complications. Choices B, C, and D are incorrect because an erection lasting more than 2 hours (not 4 hours as stated in choice B) is a critical adverse effect that warrants immediate medical attention. Nasal congestion (choice C) and feeling flushed (choice D) are common side effects of sildenafil and typically do not necessitate immediate discontinuation of the medication or emergency intervention.

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