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 67-year-old client is discharged from the hospital with a prescription for digoxin 0.25 mg daily. Which instruction by the practical nurse (PN) is correct?

• A. Take the medication in the morning before getting out of bed.
• B. Do not take the medication if the heartbeat is irregular or slow.
• C. Expect some vision changes due to the medication.
• D. Increase intake of foods rich in potassium.

Correct answer: B

Rationale: The correct instruction for a client taking digoxin is not to take the medication if the heartbeat is irregular or slow. Digoxin can affect the heart rhythm, so it is crucial to monitor the pulse rate. In case of irregular or slow heartbeats, the medication should be withheld, and the healthcare provider should be consulted. This step is necessary to prevent potential complications associated with digoxin therapy. Choices A, C, and D are incorrect. Taking digoxin in the morning before getting out of bed is not a specific requirement. Vision changes are not a common side effect of digoxin. While digoxin can affect potassium levels, it is not advised to increase potassium intake without healthcare provider guidance.

3. The healthcare provider notes that a client has a new prescription for 20 mEq of potassium. The IV site is inflamed but not tender, and has a blood flashback. What action should the healthcare provider take?

• A. Obtain a liter of normal saline with 20 mEq of KCl
• B. Contact the healthcare provider to clarify the prescription
• C. Withhold the prescription medication until a new IV is started
• D. Fax the prescription to the pharmacy for immediate dispensing

Correct answer: B

Rationale: The healthcare provider should contact the prescriber to clarify the prescription because an inflamed IV site may indicate potential issues with administering the medication. It is important to ensure that the prescription is appropriate and safe for the client before proceeding with administration. Option A is incorrect because administering potassium through an inflamed IV site can lead to further complications. Option C is not the best course of action as clarifying the prescription first is essential. Option D is also incorrect as the focus should be on ensuring the safety of the client before dispensing the medication.

4. A client with chronic kidney disease is prescribed erythropoietin. The nurse should monitor for which potential adverse effect?

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

Correct answer: A

Rationale: Erythropoietin is a medication commonly used to stimulate red blood cell production in individuals with chronic kidney disease. One of the potential adverse effects of erythropoietin therapy is hypertension. The increased production of red blood cells can lead to elevated blood pressure levels. Therefore, monitoring for hypertension is essential to ensure the client's safety and well-being while on this medication. Choices B, C, and D are incorrect because hypotension, tachycardia, and bradycardia are not typically associated with erythropoietin therapy. Hypertension is the primary adverse effect to monitor in this case.

5. A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. What action should the nurse take?

• A. Explain that the medication may take time to show improvement in symptoms
• B. Withhold the medication and notify the healthcare provider
• C. Advise the client to undergo liver function tests
• D. Document the assessment findings in the electronic health record

Correct answer: D

Rationale: In this scenario, the nurse's priority is to document the assessment findings in the electronic health record. This action is crucial for maintaining an accurate record of the client's health status and can provide valuable information for the healthcare team. While it is important to monitor the client's response to riluzole, explaining that the medication may take time to show improvement (Choice A) would be more appropriate if the client was expecting immediate results. Withholding the medication and notifying the healthcare provider (Choice B) should not be the initial action without further assessment or guidance. Advising the client to undergo liver function tests (Choice C) is not directly related to the current situation of weakness and muscle atrophy.

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