Nursing Elites

1. A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered dose inhaler. Which of the following statements by the parent indicates the need for further teaching?

• A. I will give my child a dose as soon as wheezing starts.
• B. My child should rinse out his mouth after using the inhaler.
• C. My child should exhale completely before placing the inhaler in his mouth.
• D. If my child has difficulty breathing in the dose, a spacer can be used.

Correct answer: A

Rationale: The correct answer is A. Cromolyn sodium is a preventive medication and should not be used as a rescue inhaler when wheezing starts. This indicates a need for further teaching as the parent should understand that cromolyn sodium is not meant for immediate relief of symptoms. Choice B is correct as rinsing the mouth after using the inhaler helps reduce the risk of oral thrush, a common side effect. Choice C is correct as exhaling completely before using the inhaler helps ensure proper inhalation of the medication. Choice D is correct as a spacer can be used if the child has difficulty coordinating breathing with the inhaler, improving medication delivery.

2. A nurse is providing discharge teaching to a client who has heart failure and a new prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching?

• A. I know that blurred vision is something I will expect to happen while taking digoxin.
• B. I will measure my urine output each day and document it in my diary.
• C. I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute.
• D. I will eat fruits and vegetables that have high potassium content every day.

Correct answer: D

Rationale: Clients taking digoxin and furosemide are at risk for hypokalemia. Eating potassium-rich foods can help maintain normal potassium levels.

3. A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan?

• A. Stop taking the medication if a rash occurs.
• B. Take the medication on an empty stomach to enhance absorption.
• C. Schedule the medication on alternate days to decrease adverse effects.
• D. Treat shortness of breath with an extra dose of the medication.

Correct answer: C

Rationale: When initiating long-term oral prednisone therapy for asthma, it is essential to schedule the medication on alternate days. This approach helps reduce the risk of adverse effects commonly associated with corticosteroid use. Choice A is incorrect because abrupt discontinuation of prednisone can lead to adrenal insufficiency. Choice B is incorrect as prednisone should be taken with food to minimize gastrointestinal side effects. Choice D is incorrect because using an extra dose of prednisone to treat shortness of breath is not appropriate and can lead to overdosing.

4. When administering subcutaneous epinephrine for a client experiencing anaphylaxis, what adverse effect should the nurse monitor for?

• A. Hypotension
• B. Hyperthermia
• C. Hypoglycemia
• D. Tachycardia

Correct answer: D

Rationale: The correct adverse effect to monitor for when administering subcutaneous epinephrine for anaphylaxis is tachycardia. Epinephrine stimulates adrenergic receptors, leading to an increased heart rate (tachycardia). Hypotension (Choice A) is less likely due to the vasoconstrictive effects of epinephrine. Hyperthermia (Choice B) and hypoglycemia (Choice C) are not commonly associated with epinephrine administration for anaphylaxis.

5. A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number)

• A. 20 mg
• B. 15 mg
• C. 10 mg
• D. 30 mg

Correct answer: A

Rationale: To calculate the dosage per dose, first, convert the toddler's weight from pounds to kilograms: 22 lb / 2.2 = 10 kg. Then, multiply the weight by the dosage: 4 mg × 10 kg = 40 mg/day. Since this total daily dose is divided into 2 equal doses, the nurse should administer 20 mg per dose. Therefore, the correct answer is 20 mg. Choice B (15 mg) is incorrect because it does not account for the correct weight conversion and dosage calculation. Choice C (10 mg) is incorrect as it only considers the weight conversion but doesn't multiply it by the dosage. Choice D (30 mg) is incorrect as it miscalculates the dosage by not dividing the total daily dose into 2 equal parts.

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