Nursing Elites

1. A client vomits 30 minutes after receiving a dose of hydromorphone on the first postoperative day. What initial intervention is best for the practical nurse (PN) to implement?

• A. Obtain a prescription for nasogastric intubation.
• B. Administer a prn dose of ondansetron.
• C. Reduce the next scheduled dose of hydromorphone.
• D. Assess the client's abdomen and bowel sounds.

Correct answer: B

Rationale: In this scenario, the client's vomiting is likely due to the hydromorphone administration, indicating a need for an antiemetic such as ondansetron to address the nausea. Nasogastric intubation (Choice A) is not necessary at this point as the client is vomiting, not experiencing an obstruction. While reducing the dose of hydromorphone (Choice C) may be considered later, the immediate focus should be managing the client's symptoms. Assessing the client's abdomen and bowel sounds (Choice D) can be important but is not the initial priority when addressing the vomiting post hydromorphone administration.

2. The healthcare provider has administered albuterol as an inhaled medication. The healthcare provider should monitor the client for which possible adverse reaction?

• A. Enuresis
• B. Lethargy
• C. Depression
• D. Tachycardia

Correct answer: D

Rationale: Albuterol is a bronchodilator in the adrenergic category. Its actions and adverse effects are similar to adrenaline or epinephrine. The healthcare provider should monitor the client for tachycardia, which is a common adverse effect of albuterol due to its stimulant effect on beta-2 receptors. Enuresis, or night bed-wetting, is not an adverse effect associated with albuterol. Additionally, the client should be monitored for anxiety as a potential adverse effect, not lethargy or depression, which are not typically associated with albuterol administration.

3. A client is receiving metronidazole for Clostridium difficile pseudomembranous colitis. Which information should the nurse include in this client's medication teaching plan?

• A. Drink adequate water daily
• B. Take with food
• C. Avoid alcohol consumption
• D. Store medication in the refrigerator

Correct answer: C

Rationale: The correct information to include in the medication teaching plan for a client receiving metronidazole for Clostridium difficile pseudomembranous colitis is to avoid alcohol consumption. Metronidazole can cause a disulfiram-like reaction when combined with alcohol, leading to symptoms such as nausea, vomiting, flushing, and headache. Therefore, it is crucial for the client to abstain from alcohol while taking this medication to prevent adverse effects and ensure treatment effectiveness. Choices A, B, and D are incorrect. Drinking adequate water daily is a general health recommendation but not specific to metronidazole use. Taking with food is not necessary for metronidazole, and in fact, it is recommended to be taken on an empty stomach for better absorption. Storing the medication in the refrigerator is also incorrect, as metronidazole should be stored at room temperature.

4. After receiving the third dose of a new oral anticoagulant prescription, which action should the nurse implement? Select all that apply.

• A. Notify the healthcare provider of the finding
• B. Provide a PRN NSAID for gum discomfort
• C. Review the most recent coagulation lab values
• D. Complete a medication variance report

Correct answer: C

Rationale: Reviewing the most recent coagulation lab values is crucial after receiving multiple doses of a new oral anticoagulant to ensure the patient is within the desired therapeutic range and to prevent adverse events related to over or under-anticoagulation. It is essential to monitor these values closely to adjust the dosage if needed. Notifying the healthcare provider of any concerning findings is important, but it may not be the immediate priority after receiving the third dose. Providing a PRN NSAID for gum discomfort is not typically indicated with oral anticoagulant therapy, as it may increase the risk of bleeding. Completing a medication variance report is more relevant in cases of medication errors or discrepancies, which may not apply in this scenario.

5. A practical nurse (PN) is preparing to administer a scheduled dose of furosemide to a client. Which laboratory value is most important for the PN to review before administering the medication?

• A. Serum calcium level
• B. Serum potassium level
• C. Serum sodium level
• D. Serum magnesium level

Correct answer: B

Rationale: The correct answer is to review the client's serum potassium level before administering furosemide. Furosemide, a loop diuretic, can lead to hypokalemia, making it crucial to assess potassium levels to prevent potential complications like cardiac arrhythmias associated with low potassium levels.

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