Nursing Elites

1. A client is receiving Morphine IV for pain management. Which of the following actions should the nurse take to monitor for adverse effects?

• A. Monitor the client's respiratory rate every 15 minutes.
• B. Monitor the client's blood pressure every 30 minutes.
• C. Monitor the client's oxygen saturation every hour.
• D. Monitor the client's heart rate every 5 minutes.

Correct answer: A

Rationale: The correct action for the nurse to monitor for adverse effects of Morphine IV is to check the client's respiratory rate every 15 minutes. Respiratory depression is a potentially life-threatening adverse effect of Morphine. Monitoring the respiratory rate frequently allows for early detection and intervention if needed. Monitoring blood pressure, oxygen saturation, or heart rate alone may not provide early signs of respiratory depression, which is a critical adverse effect of Morphine IV.

2. A healthcare professional is preparing to administer eye drops to a client. Which of the following actions should the healthcare professional take? (Select all that apply.)

• A. Have the client lie on their side.
• B. Ask the client to look up at the ceiling.
• C. Tell the client to blink when the drops enter their eye.
• D. Drop the medication into the center of the client's conjunctival sac.

Correct answer: B

Rationale: When administering eye drops, it is essential to ask the client to look up at the ceiling. This position helps prevent the drops from falling onto the cornea, ensuring that the medication is properly absorbed without causing discomfort or irritation.

3. 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.

4. A nurse is providing instructions to a client who has a prescription for Amoxicillin and Clarithromycin to treat a Peptic Ulcer. Which of the following information should the nurse include in the teaching?

• A. Take these medications with foo '
• B. These medications can turn your stool black.'
• C. These medications can cause photosensitivity.'
• D. The purpose of these medications is to decrease the pH of gastric juices in the stomach.'

Correct answer: A

Rationale: The nurse should instruct the client to take these medications with food to reduce GI disturbances.

5. A client has a new prescription for Alteplase. Which of the following actions should the nurse plan to take?

• A. Administer the medication within 4 hours of the onset of symptoms.
• B. Reconstitute the medication with sterile saline.
• C. Administer heparin concurrently with the Alteplase infusion.
• D. Monitor for changes in level of consciousness.

Correct answer: D

Rationale: Alteplase is a thrombolytic agent used to dissolve blood clots. Patients receiving Alteplase are at risk for bleeding complications, including intracranial bleeding. Monitoring for changes in the level of consciousness is crucial as it can indicate early signs of bleeding, such as increased intracranial pressure. This rapid assessment allows for timely intervention and prevention of further complications. Choices A, B, and C are incorrect. Administering Alteplase within 4 hours of symptom onset is related to the time-sensitive nature of thrombolytic therapy for conditions like acute myocardial infarction or ischemic stroke. Reconstituting Alteplase with sterile saline is a correct step in preparing the medication for administration. Administering heparin concurrently with Alteplase is generally avoided due to the increased risk of bleeding.

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