Nursing Elites

1. A client is being monitored while receiving bethanechol chloride (Urecholine) for urinary retention. Which of the following indicates a therapeutic effect of this medication?

• A. Increased heart rate
• B. Increased peristalsis
• C. Passage of flatus
• D. Urinary output of 50 mL per hour

Correct answer: D

Rationale: Bethanechol chloride (Urecholine) is administered to stimulate the bladder and treat urinary retention. The therapeutic effect is indicated by an increased urinary output, as it demonstrates the medication's ability to prompt the bladder to empty. Increased heart rate and passage of flatus are unrelated to the therapeutic effects of bethanechol. Although bethanechol can increase peristalsis, the primary therapeutic goal is to address urinary retention.

2. A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:

• A. 2 to 4 hours after administration
• B. 4 to 12 hours after administration
• C. 16 to 18 hours after administration
• D. 18 to 24 hours after administration

Correct answer: B

Rationale: Humulin NPH is an intermediate-acting insulin with a peak action time of 4 to 12 hours after administration. During this period, the risk of hypoglycemic reactions is highest. It is important for the client to be aware of this timing to prevent, recognize, and manage hypoglycemia effectively.

3. The healthcare provider should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be:

• A. Prednisone
• B. Sulfisoxazole
• C. Furosemide (Lasix)
• D. Intravenous immune globulin (IVIG)

Correct answer: B

Rationale: Children with spina bifida, especially those with a neurogenic bladder, are at an increased risk of urinary tract infections. Sulfisoxazole, an antibiotic, is commonly prescribed prophylactically to prevent UTIs in this population. Prednisone (Choice A) is a corticosteroid and is not typically used for prophylaxis in this scenario. Furosemide (Lasix) (Choice C) is a diuretic used to treat fluid retention and hypertension, not for preventing UTIs. Intravenous immune globulin (IVIG) (Choice D) is used to boost the immune system, not for UTI prophylaxis in this case.

4. A client is instructed to take levothyroxine (Synthroid). The medication should be taken:

• A. With food
• B. At lunchtime
• C. On an empty stomach
• D. At bedtime with a snack

Correct answer: C

Rationale: Levothyroxine should be taken on an empty stomach to enhance absorption. Taking it with food or at bedtime can interfere with its absorption, reducing its effectiveness. Therefore, it is essential for the client to take levothyroxine on an empty stomach to ensure optimal therapeutic outcomes.

5. A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will:

• A. Watch for irritability as a side effect.
• B. Take the tablet with a full glass of water.
• C. Take an extra dose if the cough is accompanied by fever.
• D. Crush the sustained-release tablet if immediate relief is needed.

Correct answer: B

Rationale: Guaifenesin is an expectorant used to help loosen mucus and make coughs more productive. Taking it with a full glass of water helps decrease the viscosity of secretions, making it easier to expel mucus from the respiratory tract. It is important not to crush sustained-release tablets, as this can alter the intended release of the medication and lead to potential adverse effects.

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