Nursing Elites

1. A client with kidney stones from secondary hyperoxaluria requires medication. Which medication should the nurse anticipate administering?

• A. Phenazopyridine (Pyridium)
• B. Propantheline (Pro-Banthine)
• C. Tolterodine (Detrol LA)
• D. Allopurinol (Zyloprim)

Correct answer: D

Rationale: The correct answer is D: Allopurinol (Zyloprim). Allopurinol is used to treat kidney stones caused by secondary hyperoxaluria. This medication helps prevent the formation of certain types of kidney stones. Choices A, B, and C are incorrect. Phenazopyridine (Pyridium) is given to clients with urinary tract infections, not for kidney stones. Propantheline (Pro-Banthine) is an anticholinergic medication used for treating certain gastrointestinal conditions, not kidney stones. Tolterodine (Detrol LA) is also an anticholinergic with smooth muscle relaxant properties, primarily used to treat overactive bladder conditions, not kidney stones.

2. How can a nurse best help a client undergoing a bone marrow aspiration and biopsy, along with two upset family members, manage anxiety during the procedure?

• A. Allow the client's family to stay for emotional support.
• B. Accompany the client silently.
• C. Encourage the client to take slow, deep breaths to promote relaxation.
• D. Provide the client an opportunity to verbalize emotions.

Correct answer: C

Rationale: Encouraging the client to take slow, deep breaths is an effective way for the nurse to help the client manage anxiety during the bone marrow aspiration and biopsy procedure. Slow, deep breathing can promote relaxation and help reduce anxiety levels. Choice A, allowing the client's family to stay for emotional support, may provide comfort but does not address a direct intervention to help manage anxiety. Choice B, staying with the client silently, may not actively help the client address their anxiety. Choice D, allowing the client to express feelings, is important but may not directly address anxiety management during the procedure.

3. A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child’s dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?

• A. 5 mL PO BID
• B. 5 mL PO daily
• C. 10 mL PO BID
• D. 10 mL PO daily

Correct answer: A

Rationale: The correct answer is A: '5 mL PO BID.' To calculate the child’s daily dose requirement, you multiply the child's weight (10 kg) by the prescribed dosage per kg, which is 8 mg for TMP and 40 mg for SMX. This results in a total daily requirement of 80 mg of TMP and 400 mg of SMX. To divide this into two doses, each dose should contain half of the total daily requirement, which is 40 mg TMP and 200 mg SMX. Since the liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL, the correct dose per administration is 5 mL. Therefore, 5 mL PO BID is the correct order. Choice B, '5 mL PO daily,' is incorrect as the total daily dose needs to be divided into two doses. Choices C and D, '10 mL PO BID' and '10 mL PO daily,' respectively, are incorrect as they do not align with the calculated dosage requirements based on the child's weight and the prescribed dosage per kg.

4. What is a key intervention for a patient with diabetic ketoacidosis (DKA)?

• A. Administering insulin
• B. Administering IV fluids
• C. Administering oral glucose
• D. Administering oral fluids

Correct answer: A

Rationale: Administering insulin is a crucial intervention for a patient with diabetic ketoacidosis (DKA) because it helps in managing hyperglycemia and ketosis by promoting the uptake of glucose by cells and inhibiting the production of ketones. IV fluids are necessary to correct dehydration and electrolyte imbalances commonly seen in DKA but are not the primary treatment for the condition. Administering oral glucose would exacerbate hyperglycemia in a patient with DKA, while administering oral fluids alone would not effectively address the underlying metabolic disturbances seen in DKA.

5. The client with diabetes mellitus should be cautioned by the nurse taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause which of the following?

• A. Hypokalemia.
• B. Hyperkalemia.
• C. Hypocalcemia.
• D. Disulfiram (Antabuse)-like symptoms.

Correct answer: D

Rationale: The correct answer is D: Disulfiram (Antabuse)-like symptoms. When a client with diabetes mellitus taking a sulfonylurea consumes alcohol, it can lead to disulfiram-like symptoms, such as nausea, flushing, and palpitations. Choice A, hypokalemia, is incorrect because sulfonylureas do not typically lead to low potassium levels. Choice B, hyperkalemia, is incorrect as sulfonylureas are not associated with high potassium levels. Choice C, hypocalcemia, is also incorrect because sulfonylureas are not known to cause low calcium levels.

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