Nursing Elites

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

• A. You should have your white blood cell count checked regularly.
• B. You should take this medication on an empty stomach.
• C. You should avoid eating foods high in tyramine.
• D. You should avoid taking this medication with milk.

Correct answer: A

Rationale: The correct answer is A: 'You should have your white blood cell count checked regularly.' Clozapine can lead to agranulocytosis, a serious condition characterized by a low white blood cell count. Regular monitoring of the white blood cell count is crucial to detect this adverse effect early and prevent serious complications. Choices B, C, and D are incorrect because taking clozapine on an empty stomach, avoiding foods high in tyramine, or avoiding taking the medication with milk are not specific instructions related to the potential adverse effect of agranulocytosis associated with clozapine.

2. Why should the client diagnosed with rheumatic heart disease be advised to notify the dentist before dental procedures?

• A. The client requires prophylactic antibiotics before treatment.
• B. The client may experience dysrhythmias with high-speed drills.
• C. The client may have an adverse reaction to lidocaine with epinephrine.
• D. The client may develop heart failure during stressful events.

Correct answer: A

Rationale: Clients with rheumatic heart disease are at risk for infective endocarditis, a serious infection of the heart lining or valves. They need prophylactic antibiotics before invasive procedures, including dental work, to prevent this life-threatening complication. While dysrhythmias with high-speed drills, adverse reactions to local anesthesia, and the risk of heart failure during stressful events are all concerns for clients with heart conditions, the primary reason for notifying the dentist before dental procedures in rheumatic heart disease is the need for prophylactic antibiotics to prevent infective endocarditis.

3. The nurse is caring for a client with hypertension who is prescribed enalapril (Vasotec). The nurse should monitor the client for which potential adverse effect?

• A. Hypertension
• B. Hypotension
• C. Tachycardia
• D. Hyperglycemia

Correct answer: B

Rationale: The correct answer is B: Hypotension. Enalapril is an ACE inhibitor that works by dilating blood vessels and reducing blood pressure. Therefore, a potential adverse effect of enalapril is hypotension, not hypertension (choice A), tachycardia (choice C), or hyperglycemia (choice D). Monitoring for hypotension is crucial to prevent complications.

4. A client with a diagnosis of angina pectoris returns to the nursing unit after experiencing an angioplasty. The nurse reinforces instructions to the client regarding the procedure and home care measures. Which statement by the client indicates an understanding of the instructions?

• A. I am considering cutting my workload.
• B. I need to cut down on cigarette smoking.
• C. I am so relieved that my heart is repaired.
• D. I need to adhere to my dietary restrictions.

Correct answer: D

Rationale: The correct answer is D because adhering to dietary restrictions is crucial in managing heart health post-angioplasty. Choice A focuses on workload, choice B mentions smoking, and choice C reflects relief about heart repair, which are important but do not directly relate to post-angioplasty care instructions.

5. A nurse is assessing a client who has been taking levothyroxine for hypothyroidism. Which of the following findings should the nurse report to the provider?

• A. Weight loss
• B. Insomnia
• C. Heat intolerance
• D. Dry skin

Correct answer: C

Rationale: The correct answer is C: Heat intolerance. Heat intolerance is a sign of levothyroxine toxicity and requires immediate attention. Weight loss may actually be an expected outcome of levothyroxine therapy as it can help regulate metabolism in hypothyroidism. Insomnia can occur as a side effect of levothyroxine but is not as concerning as heat intolerance. Dry skin is a common symptom of hypothyroidism and may improve with levothyroxine therapy, so it is not a priority finding to report to the provider.

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