Nursing Elites

1. A client has a prescription for albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs) by metered-dose inhaler. The medications are to be administered by the nurse by giving the:

• A. Albuterol first and then the beclomethasone dipropionate
• B. Beclomethasone dipropionate first and then the albuterol
• C. Alternating a single puff of each, beginning with the albuterol
• D. Alternating a single puff of each, beginning with the beclomethasone dipropionate

Correct answer: A

Rationale: Albuterol, as a bronchodilator, should be administered first to help open up the airways, followed by beclomethasone dipropionate to reduce inflammation in the airways. This sequence ensures optimal therapeutic effects of the medications.

2. Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select one that doesn't apply.

• A. Signs of hepatitis
• B. Flu-like syndrome
• C. Low neutrophil count
• D. Vitamin B6 deficiency

Correct answer: D

Rationale: Rifabutin is known to cause side effects such as hepatitis, flu-like syndrome, low neutrophil count, and ocular pain or blurred vision. Vitamin B6 deficiency is not associated with rifabutin but is a side effect of isoniazid (INH). Therefore, the nurse should not monitor for Vitamin B6 deficiency when administering rifabutin.

3. When administering etanercept (Enbrel) to a client with rheumatoid arthritis for 3 weeks, what is the most important assessment for the nurse to perform?

• A. Assessing the injection site for itching and edema
• B. Monitoring white blood cell counts and platelet counts
• C. Evaluating for fatigue and joint pain in the client
• D. Checking for a metallic taste in the mouth and loss of appetite

Correct answer: B

Rationale: The priority when administering etanercept (Enbrel) to a client with rheumatoid arthritis is to monitor white blood cell counts and platelet counts. Etanercept can lead to infections and pancytopenia, making it crucial to assess for changes in these blood parameters to detect any potential complications early on.

4. A client is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?

• A. The development of complaints of insomnia
• B. The development of audible expiratory wheezes
• C. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication
• D. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication

Correct answer: B

Rationale: The development of audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm, associated with propranolol. Beta-blockers can trigger bronchospasm, especially in clients with chronic obstructive pulmonary disease or asthma. This complication can lead to significant respiratory distress and should be addressed promptly to prevent further complications.

5. A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:

• A. Hypercalcemia
• B. Peripheral neuritis
• C. Small blood vessel spasm
• D. Impaired peripheral circulation

Correct answer: B

Rationale: The client's symptoms of numbness, paresthesias, and tingling in the extremities indicate peripheral neuritis, a common side effect of isoniazid (INH). This condition can be managed by supplementing with pyridoxine (vitamin B6) to minimize the symptoms.

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