Nursing Elites

1. A client receiving chemotherapy with Methotrexate asks why Leucovorin is being given. Which of the following responses should the nurse use?

• A. Leucovorin reduces the risk of a transfusion reaction from Methotrexate.
• B. Leucovorin increases platelet production and prevents bleeding.
• C. Leucovorin potentiates the cytotoxic effects of Methotrexate.
• D. Leucovorin protects healthy cells from Methotrexate's toxic effects.

Correct answer: D

Rationale: Leucovorin, a folic acid derivative and an antagonist to Methotrexate, is given within 12 hours of high doses of Methotrexate to protect healthy cells from the toxic effects of Methotrexate. It helps to reduce the bone marrow suppression and gastrointestinal side effects caused by Methotrexate, supporting the client's overall well-being during chemotherapy treatment. Choices A, B, and C are incorrect because Leucovorin does not reduce the risk of a transfusion reaction from Methotrexate, increase platelet production, prevent bleeding, or potentiate the cytotoxic effects of Methotrexate. Instead, Leucovorin works by rescuing healthy cells from the toxic effects of Methotrexate.

2. What instruction should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine for a client with poison ivy?

• A. Administer the medication with food.
• B. Chew on sugarless gum or suck on hard, sour candies.
• C. Place a humidifier at your bedside every evening.
• D. Discontinue the medication and notify your provider.

Correct answer: B

Rationale: The correct instruction for dry mouth associated with diphenhydramine is to chew on sugarless gum or suck on hard, sour candies. These actions stimulate saliva production, providing relief from dry mouth. Administering the medication with food (Choice A) may help reduce stomach upset but won't address dry mouth. Placing a humidifier at the bedside (Choice C) can help with dry air-related issues but won't specifically target dry mouth. Discontinuing the medication (Choice D) without consulting the provider is not recommended and may lead to inadequate treatment of poison ivy.

3. A client with a UTI and a history of recurrent infections asks why the provider has not yet prescribed an antibiotic. The nurse should explain that the provider has to wait for the results of which of the following laboratory tests to identify which antibiotic to prescribe?

• A. Gram stain
• B. Culture
• C. Sensitivity
• D. Specific gravity

Correct answer: C

Rationale: In the case of a UTI, a sensitivity test is crucial as it identifies the most effective antibiotic to target the specific microorganism causing the infection. This test helps in prescribing the appropriate antibiotic for successful treatment and preventing antibiotic resistance. While a Gram stain and culture are important in diagnosing a UTI, the sensitivity test specifically determines the most suitable antibiotic. Specific gravity, on the other hand, is not related to identifying the appropriate antibiotic for a UTI.

4. A client has a new prescription for Pancrelipase. Which of the following instructions should the nurse include?

• A. Take the medication with meals and snacks.
• B. Expect your urine to turn orange.
• C. Increase your intake of high-calcium foods.
• D. Avoid consuming dairy products.

Correct answer: A

Rationale: The correct answer is A: 'Take the medication with meals and snacks.' Pancrelipase should be taken with meals and snacks to aid in the digestion of fats, proteins, and carbohydrates. This timing ensures that the medication functions optimally by assisting in the digestion process when food is present in the gastrointestinal system. Choice B is incorrect because urine discoloration is not a common side effect of Pancrelipase. Choice C is incorrect as there is no specific need to increase high-calcium foods with Pancrelipase. Choice D is also incorrect as avoiding dairy products is not necessary when taking Pancrelipase.

5. A client with migraine headaches is starting prophylaxis therapy with Propranolol. Which finding in the client's history should the nurse report to the provider?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with first-degree heart block due to its negative inotropic and chronotropic effects. The nurse should report this finding to the provider to consider an alternative therapy to prevent potential worsening of cardiac conduction abnormalities. Choices A, B, and C are not directly contraindications to Propranolol therapy for migraine headaches and do not pose immediate risks that would require reporting to the provider.

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