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 teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests?

• A. Platelet count
• B. Electrolyte levels
• C. Thyroid function
• D. Liver function

Correct answer: D

Rationale: The correct answer is D: Liver function. Gemfibrozil can lead to hepatotoxicity, making it crucial to monitor liver function tests. Monitoring platelet count (choice A) is not specifically indicated for gemfibrozil. Electrolyte levels (choice B) and thyroid function (choice C) are not directly affected by gemfibrozil, so they are not the primary laboratory tests to monitor in this case.

3. A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take?

• A. Administer vitamin K
• B. Reduce the infusion rate
• C. Give the client a low-dose aspirin
• D. Request an INR

Correct answer: B

Rationale: An aPTT of 90 seconds is elevated, indicating a risk of bleeding due to excessive anticoagulation. The appropriate action is to reduce the infusion rate of heparin to prevent further complications. Administering vitamin K is not indicated for an elevated aPTT due to heparin therapy. Giving the client a low-dose aspirin can further increase the risk of bleeding when combined with heparin. Requesting an INR is not necessary for monitoring heparin therapy; aPTT is the more specific test for assessing heparin's therapeutic effect. Therefore, the correct action for the nurse to prepare to take is to reduce the infusion rate of heparin.

4. A healthcare professional is reviewing the laboratory results for a client who has a prescription for filgrastim. The healthcare professional should recognize that an increase in which of the following values indicates a therapeutic effect of this medication?

• A. Erythrocyte count
• B. Neutrophil count
• C. Lymphocyte count
• D. Thrombocyte count

Correct answer: B

Rationale: Filgrastim is a medication used to stimulate the production of neutrophils in patients with neutropenia. Neutrophils are a type of white blood cell that plays a crucial role in fighting off infections. Therefore, an increase in neutrophil count would indicate a therapeutic effect of filgrastim. The other options, such as erythrocyte count (red blood cells), lymphocyte count, and thrombocyte count (platelets), are not directly affected by filgrastim and would not indicate a therapeutic effect of this medication.

5. A client with ulcerative colitis has been prescribed sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

• A. Jaundice
• B. Constipation
• C. Oral candidiasis
• D. Sedation

Correct answer: A

Rationale: The correct answer is A: Jaundice. Sulfasalazine can cause liver damage as a possible adverse effect, which can manifest as jaundice. Monitoring for jaundice is crucial to detect liver-related adverse effects early. Choices B, C, and D are incorrect. Constipation, oral candidiasis, and sedation are not typically associated with sulfasalazine use. Therefore, the nurse should focus on educating the client specifically about monitoring for jaundice.

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