Nursing Elites

1. A healthcare professional is reviewing the medication list of a client scheduled for surgery. Which of the following medications places the client at risk for increased bleeding during surgery?

• A. Warfarin
• B. Acetaminophen
• C. Ibuprofen
• D. Aspirin

Correct answer: D

Rationale: Aspirin is an anticoagulant that inhibits platelet function, increasing the risk of bleeding during surgery. It is important for the healthcare professional to identify this medication, inform the surgical team, and consider withholding it prior to surgery to reduce the risk of excessive bleeding. Warfarin is also an anticoagulant but can be managed by adjusting the dosage or monitoring INR levels. Acetaminophen and ibuprofen are not associated with increased bleeding risk as they do not affect platelet function like aspirin.

2. A client is prescribed Spironolactone. Which of the following laboratory findings should the nurse monitor and report to the provider?

• A. Sodium level of 138 mEq/L
• B. Potassium level of 5.2 mEq/L
• C. Chloride level of 100 mEq/L
• D. Calcium level of 9.5 mg/dL

Correct answer: B

Rationale: Spironolactone is a potassium-sparing diuretic, causing potassium retention, potentially leading to elevated potassium levels. A potassium level of 5.2 mEq/L is above the normal range (3.5-5.0 mEq/L), indicating hyperkalemia, a serious condition. Elevated potassium levels can lead to life-threatening cardiac arrhythmias. Monitoring and reporting high potassium levels promptly to the healthcare provider are crucial to prevent potential complications. Sodium, chloride, and calcium levels are not directly influenced by Spironolactone, making choices A, C, and D incorrect.

3. A client is prescribed an IM dose of penicillin. The client reports developing a rash after taking penicillin 3 years ago. What should the nurse do?

• A. Administer the prescribed dose.
• B. Withhold the medication.
• C. Ask the provider to change the prescription to an oral form.
• D. Administer an oral antihistamine at the same time.

Correct answer: B

Rationale: The nurse should withhold the medication and inform the provider of the client's previous rash after taking penicillin. This history suggests a potential allergic reaction to penicillin, which can range from mild to severe anaphylaxis. Notifying the provider allows for an alternative antibiotic to be prescribed, considering the client's allergy to penicillin. It is crucial to avoid administering a medication that could potentially lead to a severe allergic reaction in the client. Administering the prescribed dose (Choice A) could be harmful due to the potential for an allergic reaction. Changing the prescription to an oral form (Choice C) does not address the underlying issue of a potential penicillin allergy. Administering an oral antihistamine (Choice D) without consulting the provider may not be sufficient to prevent a severe allergic reaction.

4. A client has a new prescription for Hydrochlorothiazide. Which of the following adverse effects should the nurse monitor?

• A. Hyponatremia
• B. Hyperkalemia
• C. Hypercalcemia
• D. Hypoglycemia

Correct answer: A

Rationale: Corrected Rationale: Hydrochlorothiazide is a diuretic known to cause electrolyte imbalances, particularly hyponatremia (low sodium levels). The nurse should closely monitor the client for signs of hyponatremia by assessing their electrolyte levels. Choice B, Hyperkalemia, is incorrect as hydrochlorothiazide is more likely to cause hypokalemia (low potassium levels) rather than hyperkalemia. Choice C, Hypercalcemia, is incorrect because hydrochlorothiazide is not known to cause increased calcium levels. Choice D, Hypoglycemia, is also incorrect as it is not a common adverse effect of hydrochlorothiazide.

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

• A. Monitor for signs of bleeding.
• B. Avoid foods high in vitamin K.
• C. Expect to have increased urination.
• D. Take the medication with an antacid.

Correct answer: A

Rationale: The correct instruction for a client starting Warfarin is to monitor for signs of bleeding. Warfarin is an anticoagulant that increases the risk of bleeding; therefore, it is crucial for the client to watch for any signs of bleeding, such as easy bruising, prolonged bleeding from cuts, blood in urine or stools, or unusual bleeding from gums or nose. If any of these signs occur, the client should promptly report them to their healthcare provider for further evaluation and management. Choices B, C, and D are incorrect because avoiding foods high in vitamin K is related to other medications like Coumadin, increased urination is not a common side effect of Warfarin, and taking Warfarin with an antacid can potentially interfere with its absorption.

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