Nursing Elites

1. A client with gastroesophageal reflux disease (GERD) is prescribed omeprazole. The nurse should reinforce which instruction?

• A. Take this medication in the morning before breakfast.
• B. Take this medication with meals.
• C. Avoid taking this medication with antacids.
• D. Take this medication at bedtime.

Correct answer: A

Rationale: The correct instruction for a client with GERD prescribed omeprazole is to take the medication in the morning before breakfast. Omeprazole works best when taken on an empty stomach, approximately 30 minutes before the first meal of the day. This timing maximizes its effectiveness in reducing stomach acid production and helps manage symptoms of GERD more efficiently. Choice B is incorrect because taking omeprazole with meals may reduce its efficacy as it needs an empty stomach for optimal absorption. Choice C is incorrect because omeprazole can be taken with or without food, but it should not be taken with antacids as they can affect its absorption. Choice D is incorrect because taking omeprazole at bedtime is less effective compared to taking it before breakfast due to the circadian rhythm of gastric acid secretion.

2. A client with diabetes mellitus is prescribed insulin glargine. What information should the practical nurse (PN) provide to the client about this medication?

• A. Administer the insulin at mealtimes.
• B. Do not mix this insulin with other insulins.
• C. Shake the vial well before use.
• D. Store the insulin in the freezer.

Correct answer: B

Rationale: Insulin glargine is a long-acting insulin that should not be mixed with other insulins in the same syringe. Mixing it with other insulins can alter its pharmacokinetics and effectiveness. Insulin glargine is usually administered at the same time each day, often at bedtime, to provide a consistent basal level of insulin over 24 hours.

3. A client receiving enalapril reports a persistent dry cough. The nurse should explain that this side effect is related to which medication action?

• A. It reduces the production of angiotensin II.
• B. It increases the production of angiotensin II.
• C. It causes increased production of bradykinin.
• D. It increases the production of aldosterone.

Correct answer: C

Rationale: The correct answer is C. Enalapril, an ACE inhibitor, inhibits the conversion of angiotensin I to angiotensin II, leading to increased levels of bradykinin. The accumulation of bradykinin is responsible for the persistent dry cough associated with ACE inhibitors like enalapril. Choices A, B, and D are incorrect because enalapril does not directly affect the production of angiotensin II or aldosterone. Instead, it primarily impacts the renin-angiotensin-aldosterone system by inhibiting the conversion of angiotensin I to angiotensin II, leading to bradykinin accumulation.

4. A client with diabetes mellitus type 2 is prescribed glyburide. The nurse should monitor for which potential adverse effect?

• A. Hypoglycemia
• B. Weight gain
• C. Nausea
• D. Hyperglycemia

Correct answer: A

Rationale: The correct potential adverse effect to monitor for when a client with diabetes mellitus type 2 is prescribed glyburide is hypoglycemia. Glyburide can lead to hypoglycemia, particularly in individuals who do not eat regularly, by stimulating the release of insulin from the pancreas, which can lower blood sugar levels. It is crucial for the nurse to monitor for signs and symptoms of hypoglycemia, such as confusion, sweating, and palpitations, to prevent complications and provide timely interventions.

5. A client diagnosed with a herniated disc is prescribed hydrocodone/acetaminophen 10 mg/300 mg prn every 4 to 6 hours. As the practical nurse (PN) enters the client's room to administer the requested medication, the client is seen talking and laughing with visiting family. What action should the PN take?

• A. Hold the pain medication until after the visitors leave.
• B. Notify the healthcare provider of the client's drug-seeking behavior.
• C. Administer analgesia as requested by the client.
• D. Inform the client that the medication is not needed based on their behavior.

Correct answer: C

Rationale: The correct action for the PN in this situation is to administer the analgesia as requested by the client. Pain management is based on the client's self-report of pain, which is the most reliable indicator of pain intensity. Analgesics should be given promptly when pain occurs and before it worsens. Following the administration of medication, the PN should discuss the situation with the charge nurse for further guidance or assessment.

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