Nursing Elites

1. A client with hypertension is prescribed lisinopril (Zestril). Which instruction should the nurse include in the teaching plan?

• A. Avoid foods high in potassium.
• B. Avoid taking the medication with grapefruit juice.
• C. Monitor blood pressure regularly.
• D. Report any swelling of the lips or face.

Correct answer: D

Rationale: The correct instruction for the nurse to include in the teaching plan is to 'Report any swelling of the lips or face.' Lisinopril (Zestril) can cause angioedema, which is swelling of the lips or face. This is a serious side effect that should be reported immediately. Clients do not need to avoid potassium-rich foods unless instructed by their healthcare provider, should avoid taking the medication with grapefruit juice, and should monitor their blood pressure regularly, not just weekly.

2. A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered?

• A. Intramuscularly in the deltoid muscle
• B. Subcutaneously in the gluteal muscle
• C. Subcutaneously in the outer aspect of the upper arm
• D. Intramuscularly in the anterolateral aspect of the thigh

Correct answer: C

Rationale: The MMR vaccine is best administered subcutaneously in the outer aspect of the upper arm. This route allows for proper absorption and efficacy of the vaccine while minimizing the risk of injury or discomfort to the child.

3. Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which of the following food items?

• A. Milk
• B. Water
• C. Apple juice
• D. Orange juice

Correct answer: D

Rationale: Iron absorption is enhanced by the presence of vitamin C. Orange juice is a good source of vitamin C, which can improve the absorption of iron when taken together. Therefore, administering iron supplements with orange juice is the best choice to optimize iron absorption for the child.

4. A client has been prescribed cyclosporine (Sandimmune). Which food item should the client avoid based on the medication's interaction?

• A. Red meats
• B. Orange juice
• C. Grapefruit juice
• D. Green, leafy vegetables

Correct answer: C

Rationale: Grapefruit juice should be avoided when taking cyclosporine because it inhibits the metabolism of the medication, leading to increased blood levels and a higher risk of toxicity. It is important for the client to follow this dietary instruction to ensure the safe and effective use of cyclosporine.

5. A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?

• A. Monitoring the leukocyte count for 2 days after the infusion
• B. Checking the frequency and consistency of bowel movements
• C. Checking serum liver enzyme levels before and after the infusion
• D. Carrying out a Hematest on gastric fluids after the infusion is completed

Correct answer: B

Rationale: To monitor the effectiveness of infliximab (Remicade) treatment in a client with Crohn's disease, the nurse should observe the frequency and consistency of bowel movements. Infliximab is an immunomodulator that works to reduce inflammation in the colon, leading to improvements in bowel symptoms such as frequency and consistency. Monitoring these bowel patterns can provide valuable insight into the response to the medication and the overall management of Crohn's disease. Checking the leukocyte count (Choice A) is not specific to monitoring the effectiveness of infliximab for Crohn's disease. Checking serum liver enzyme levels (Choice C) may be important for liver function but does not directly monitor the effectiveness of infliximab. Carrying out a Hematest on gastric fluids (Choice D) is not relevant to monitoring the effectiveness of infliximab in Crohn's disease.

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