Nursing Elites

1. In a client with chronic renal failure receiving epoetin alfa (Epogen, Procrit), which laboratory result would indicate a therapeutic effect of the medication?

• A. Hematocrit of 32%
• B. Platelet count of 400,000 cells/mm³
• C. White blood cell count of 6000 cells/mm³
• D. Blood urea nitrogen (BUN) level of 15 mg/dL

Correct answer: A

Rationale: A hematocrit of 32% indicates a therapeutic effect of epoetin alfa in a client with chronic renal failure. Epoetin alfa is used to treat anemia in these patients by stimulating red blood cell production, leading to an increase in the hematocrit level. Monitoring the hematocrit is essential to assess the response to epoetin alfa therapy.

2. Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?

• A. Decreased urinary output
• B. Decreased blood pressure
• C. Decreased peripheral edema
• D. Decreased blood glucose level

Correct answer: A

Rationale: Desmopressin promotes renal conservation of water by increasing the permeability of kidney collecting ducts to water, resulting in decreased urinary output. Therefore, the therapeutic response expected after administering desmopressin for diabetes insipidus is a reduction in urinary output.

3. The client has reinforced instructions for taking cholestyramine (Questran). Which statement indicates a need for further instructions?

• A. I will continue taking vitamin supplements.
• B. This medication will help lower my cholesterol.
• C. This medication should only be taken with water.
• D. A high-fiber diet is important while taking this medication.

Correct answer: C

Rationale: The correct answer is C because cholestyramine should not only be taken with water. Flavored products or fruit juices can improve the taste. Choices A, B, and D are all correct statements. It is important for the client to continue taking vitamin supplements, understand that cholestyramine helps lower cholesterol, and maintain a high-fiber diet while taking this medication to enhance its effectiveness.

4. A client with severe acne is seen in the clinic, and the healthcare provider prescribes isotretinoin. The nurse reviews the client's medication record and would contact the healthcare provider if the client is taking which medication?

• A. Vitamin A
• B. Digoxin (Lanoxin)
• C. Furosemide (Lasix)
• D. Phenytoin (Dilantin)

Correct answer: A

Rationale: Isotretinoin is a metabolite of vitamin A, which can lead to toxicity when taken together. Therefore, it is crucial to avoid concurrent use of vitamin A supplements with isotretinoin. Contacting the healthcare provider to discuss discontinuing vitamin A supplements is important to prevent potential adverse effects. Choices B, C, and D are incorrect as they are not known to interact significantly with isotretinoin.

5. Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which of the following instructions does the nurse reinforce regarding administration of this medication?

• A. Administer on an empty stomach.
• B. Take the medication with a calcium-type antacid.
• C. Open the capsule and mix with food for administration.
• D. Contact the health care provider (HCP) if a sore throat occurs.

Correct answer: D

Rationale: The correct instruction for administering mycophenolate mofetil (CellCept) is to contact the healthcare provider (HCP) if unusual bleeding or bruising, sore throat, or other adverse effects occur. It is essential not to open or crush the capsules to maintain the medication's efficacy.

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