Nursing Elites

1. A female client who started chemotherapy three days ago for cancer of the breast calls the clinic reporting that she is so upset she cannot sleep. The client has several PRN medications available. Which drug should the nurse instruct her to take?

• A. Ondansetron 8mgPO no
• B. Lorazepam 2mg PO bedtime
• C. Oxycodone, acetylsalicylic acid one tablet q4 hours PRN
• D. Acetaminophen, diphenhydramine 2 capsules bedtime

Correct answer: D

Rationale: Acetaminophen and diphenhydramine help with sleep without severe side effects.

2. Prior to administration of the initial dose of the GI agent misoprostol, which information should the nurse obtain from the client?

• A. Taking an anti-emetic medication
• B. History of glaucoma
• C. Currently pregnant
• D. Allergy to aspirin

Correct answer: C

Rationale: The correct answer is C. It is crucial for the nurse to obtain information regarding the client's pregnancy status before administering misoprostol, as this medication is contraindicated in pregnancy due to its potential to cause uterine contractions. This can lead to serious complications such as miscarriage or premature birth. Therefore, assessing whether the client is currently pregnant is essential to ensure the safe administration of misoprostol. Choices A, B, and D are not directly related to the administration of misoprostol. While knowing if the client is taking an anti-emetic medication may be relevant to prevent drug interactions, a history of glaucoma and allergy to aspirin are not primary concerns before administering misoprostol.

3. In the immediate postoperative period, a client is prescribed morphine via a patient-controlled analgesia (PCA) pump. Which finding should the PN consider the highest priority in this client?

• A. Monitoring the expiration date of the PCA morphine
• B. Assessing the rate and depth of the client's respirations
• C. Reviewing the type of anesthesia used during the surgery
• D. Observing the client's signs of disorientation

Correct answer: B

Rationale: The highest priority for the PN is to assess the rate and depth of the client's respirations when a client is receiving morphine via a PCA pump. Respiratory depression is a life-threatening side effect of intravenous morphine administration. If the client's respiratory rate falls below 10 breaths/min, the PCA pump should be stopped, and the healthcare provider must be notified immediately to prevent further complications. Monitoring the expiration date of the PCA morphine is important but not the highest priority compared to assessing respiratory status. Reviewing the type of anesthesia used during the surgery is not directly related to the immediate management of the client receiving morphine via PCA. Observing signs of disorientation is also important but not as critical as assessing respirations for potential respiratory depression.

4. In the emergency department, a child is admitted for accidental ingestion of a poison. The practical nurse (PN) should know that inducing vomiting is recommended for which child?

• A. An 8-month-old who ingested four to six ibuprofen tablets
• B. A 3-year-old who drank an unknown amount of charcoal lighter fluid
• C. A 16-month-old who ingested 2 ounces of acetaminophen elixir
• D. A 2-year-old who ate a handful of automatic dishwasher detergent

Correct answer: C

Rationale: Inducing emesis is recommended for the child who ingested a large dose of acetaminophen elixir because this medication is hepatotoxic. Acetaminophen overdose can lead to severe liver damage, and prompt removal from the stomach can help reduce absorption and potential harm.

5. A client with a history of chronic kidney disease is prescribed epoetin alfa. The nurse should monitor for which potential adverse effect?

• A. Hypertension
• B. Hypotension
• C. Hyperglycemia
• D. Tachycardia

Correct answer: A

Rationale: The correct answer is A: Hypertension. Epoetin alfa can lead to hypertension as an adverse effect because it stimulates increased red blood cell production. This can result in elevated blood pressure levels, requiring careful monitoring by the nurse to prevent complications. Choice B, hypotension, is incorrect because epoetin alfa is more likely to cause hypertension rather than hypotension. Choice C, hyperglycemia, and Choice D, tachycardia, are also incorrect as they are not commonly associated with the use of epoetin alfa.

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