Nursing Elites

1. During transfusion of a unit of whole blood, a nurse is assessing a client who develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications?

• A. Epinephrine
• B. Lorazepam
• C. Furosemide
• D. Diphenhydramine

Correct answer: C

Rationale: The client's symptoms indicate circulatory overload, which can occur during blood transfusions. Furosemide, a loop diuretic, is commonly prescribed in such cases to help relieve manifestations of circulatory overload by promoting diuresis and reducing fluid volume. Epinephrine is used for severe allergic reactions, lorazepam for anxiety or seizures, and diphenhydramine for mild allergic reactions or as a sedative. Therefore, the correct choice is Furosemide (C) to manage circulatory overload during a blood transfusion.

2. When teaching a patient to take their own pulse, which medication should the nurse instruct them to monitor? (Hint: if pulse is <60 or >100, the patient should contact their healthcare provider before taking the medication)

• A. Digoxin
• B. Lithium
• C. Montelukast
• D. Phenytoin

Correct answer: A

Rationale: It is essential for patients taking Digoxin to monitor their pulse regularly. If their pulse falls below 60 or exceeds 100 beats per minute, they should contact their healthcare provider immediately. This is crucial due to Digoxin's potential to affect heart rate, making pulse monitoring a vital aspect of patient care while on this medication.

3. A client has a new prescription for Nitroglycerin to treat angina. Which of the following instructions should the nurse include?

• A. Take this medication only when chest pain occurs.
• B. Store the medication in a cool, dry place.
• C. Apply the patch to a different site each time.
• D. Avoid consuming alcohol while taking this medication.

Correct answer: C

Rationale: The correct instruction for the nurse to include is to advise the client to apply the Nitroglycerin patch to a different site each time. This is crucial to prevent skin irritation and ensure consistent absorption of the medication. Rotating application sites is important as it helps maintain the effectiveness of the treatment and reduces the risk of skin reactions. Choice A is incorrect because Nitroglycerin is often used prophylactically to prevent angina episodes rather than just for acute chest pain. Choice B is not relevant to the administration or effectiveness of the medication. Choice D, while generally a good recommendation, is not directly related to the administration of Nitroglycerin.

4. A client is receiving daily doses of Oprelvekin. Which of the following laboratory values should be monitored to determine the effectiveness of this medication?

• A. Hemoglobin
• B. Absolute neutrophil count
• C. Platelet count
• D. Total white blood cell count

Correct answer: C

Rationale: Oprelvekin is a medication that stimulates platelet production. Therefore, monitoring the platelet count is essential to assess the effectiveness of this drug. The expected outcome for oprelvekin therapy is a platelet count greater than 50,000/mm^3. Changes in platelet count can indicate the response to the medication and help in adjusting the treatment plan accordingly. Monitoring hemoglobin, absolute neutrophil count, or total white blood cell count is not directly related to the mechanism of action of Oprelvekin and therefore would not provide accurate information on the drug's effectiveness.

5. A client is taking atorvastatin for hyperlipidemia. Which of the following findings should the nurse report to the provider immediately?

• A. Headache
• B. Nausea
• C. Muscle pain
• D. Diarrhea

Correct answer: C

Rationale: Muscle pain should be reported immediately as it can indicate rhabdomyolysis, a severe adverse effect of atorvastatin. Rhabdomyolysis is characterized by muscle pain, weakness, and can lead to serious complications such as kidney damage, making it crucial for the nurse to notify the provider promptly. Headache, nausea, and diarrhea are common side effects of atorvastatin and do not require immediate reporting unless severe or persistent.

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