Nursing Elites

1. A healthy 68-year-old client asks the practical nurse (PN) whether they should take the pneumococcal vaccine. Which statement should the PN offer to the client that provides the most accurate information about this vaccine?

• A. The vaccine is given annually before the flu season to those older than 50 years.
• B. The immunization is recommended for children younger than 2 years old and all adults 65 years or older.
• C. The vaccine is for all ages and is given primarily to those traveling overseas to areas of infection.
• D. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to 5 years.

Correct answer: B

Rationale: The correct answer is B because it is usually recommended that children younger than 2 years old and adults 65 years or older get vaccinated against pneumococcal disease. This is because these age groups are more susceptible to severe complications from the infection. While the vaccine may be recommended for certain individuals with specific medical conditions at any age, the primary target groups are as mentioned in option B. Option A is incorrect as the pneumococcal vaccine is not given annually like the flu vaccine. Option C is incorrect because the vaccine is not primarily for travelers but for certain age groups and individuals with medical conditions at risk. Option D is incorrect as the vaccine's duration of protection can vary, and it is not guaranteed to prevent pneumococcal pneumonia for up to 5 years.

2. A client with a history of atrial fibrillation is prescribed warfarin. The nurse should monitor for which sign of potential bleeding?

• A. Elevated blood pressure
• B. Bruising
• C. Shortness of breath
• D. Nausea and vomiting

Correct answer: B

Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. Bruising is a common sign of potential bleeding in clients taking warfarin. Monitoring for bruising is essential as it can indicate a risk of bleeding that needs further assessment and management. Elevated blood pressure, shortness of breath, nausea, and vomiting are not direct signs of potential bleeding associated with warfarin therapy.

3. A healthcare professional prepares to administer a scheduled dose of labetalol by mouth to a client with hypertension. The client's heart rate is 48 beats/min, respirations are 16 breaths/min, and blood pressure is 150/90 mmHg.

• A. Administer the dose and monitor the client's blood pressure regularly
• B. Apply a telemetry monitor before administering the dose
• C. Assess for orthostatic hypotension before administering the dose
• D. Withhold the scheduled dose and notify the healthcare provider

Correct answer: D

Rationale: The client's low heart rate of 48 beats/min indicates bradycardia, a potential side effect of labetalol. Administering the dose in this case could further lower the heart rate, potentially causing adverse effects. Therefore, it is crucial to withhold the scheduled dose and notify the healthcare provider for further assessment and guidance. Choice A is incorrect because administering the dose without addressing the bradycardia can exacerbate the condition. Choice B is not relevant in this situation as telemetry monitoring is not the priority. Choice C is also not the priority in this case, as the focus should be on the client's bradycardia and the potential adverse effects of administering labetalol.

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

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

Correct answer: A

Rationale: Leflunomide can increase sensitivity to sunlight. While it is important to avoid excessive sun exposure, the critical instruction for the client is to avoid alcohol while taking this medication. Alcohol can potentiate the hepatotoxic effects of leflunomide, making it crucial for the client to abstain from alcohol consumption to prevent liver damage.

5. A client is prescribed metoprolol. The nurse should monitor for which common side effect of this medication?

• A. Dizziness
• B. Fatigue
• C. Orthostatic hypotension
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Dizziness. Metoprolol, a beta-blocker, can lead to dizziness as a common side effect due to its mechanism of action in reducing heart rate and blood pressure. This effect can cause a sensation of lightheadedness or unsteadiness, particularly when standing up quickly. While fatigue, orthostatic hypotension, and headache are potential side effects of metoprolol, dizziness is commonly observed and should be closely monitored by the nurse to ensure patient safety.

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