Nursing Elites

1. A client with rheumatoid arthritis is prescribed hydroxychloroquine. What instruction should the nurse include in the client's teaching plan?

• A. Avoid sunlight exposure while taking this medication.
• B. Take this medication with food to reduce gastrointestinal upset.
• C. Report any signs of infection to the healthcare provider.
• D. Report any signs of vision changes to the healthcare provider.

Correct answer: D

Rationale: Hydroxychloroquine is known to cause vision changes, including retinopathy. Therefore, it is crucial for clients to report any vision changes promptly to their healthcare provider to prevent any potential ocular complications. While sunlight exposure should be limited due to photosensitivity, the key concern with hydroxychloroquine is the risk of vision changes, not gastrointestinal upset or infections.

2. A 43-year-old female client who has had a thyroidectomy due to Grave's disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the healthcare provider?

• A. Tinnitus and dizziness
• B. Tachycardia and chest pain
• C. Dry skin and intolerance to cold
• D. Weight gain and increased appetite

Correct answer: B

Rationale: The correct answer is B: Tachycardia and chest pain. Signs and symptoms of thyroid hormone toxicity, especially in cases of excessive dosage, include tachycardia (rapid heart rate) and chest pain. These symptoms are consistent with hyperthyroidism, where the body is receiving an excessive amount of thyroid hormone. It is crucial to report these symptoms promptly to the healthcare provider to adjust the medication dosage and prevent potential complications. Choices A, C, and D are not indicative of thyroid hormone toxicity. Tinnitus and dizziness (Choice A) are not typical symptoms of thyroid hormone toxicity. Dry skin and intolerance to cold (Choice C) are more common in hypothyroidism, while weight gain and increased appetite (Choice D) are associated with hypothyroidism as well, not thyroid hormone toxicity.

3. The healthcare professional is creating a class for older adults in the community. Which information about laxative use in older adults would be important to include?

• A. Laxatives are not effective in older adults
• B. All laxatives are exactly the same
• C. Over-the-counter laxatives are misused
• D. Laxatives can cause potassium retention

Correct answer: C

Rationale: It is important to include information about the misuse of over-the-counter laxatives in older adults as they often misuse these medications, which can lead to dependency and other health issues. Option A is incorrect as laxatives can be effective in older adults when used appropriately. Option B is incorrect because not all laxatives are the same, they have different mechanisms of action and side effects. Option D is incorrect because laxatives can actually cause electrolyte imbalances like potassium depletion rather than retention.

4. A client with a history of deep vein thrombosis is prescribed dabigatran. The nurse should monitor for which potential adverse effect?

• A. Bleeding
• B. Weight gain
• C. Headache
• D. Nausea

Correct answer: A

Rationale: Dabigatran is an anticoagulant that increases the risk of bleeding. Therefore, the nurse should closely monitor the client for signs of bleeding, such as easy bruising, blood in the urine or stool, prolonged bleeding from cuts, or nosebleeds, to ensure early detection and intervention.

5. 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.

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