Nursing Elites

1. When a pediatric client is taking the beta-adrenergic blocking agent propranolol, what signs of overdose should the nurse instruct the parents to report?

• A. Seizures
• B. Increased respiratory rate
• C. Bradycardia
• D. Irritability

Correct answer: C

Rationale: When a pediatric client is taking propranolol, the nurse should instruct the parents to report signs of overdose, including bradycardia. Propranolol is a beta-blocker that can lead to dangerously slow heart rate as a sign of overdose. While increased respiratory rate, seizures, and irritability may occur in some cases, bradycardia is the most critical symptom indicating an overdose of this medication.

2. A client with hyperthyroidism is admitted for total thyroidectomy. What is the nurse's priority post-operative intervention?

• A. Monitor the client's calcium levels for hypocalcemia.
• B. Monitor for signs of respiratory distress.
• C. Administer oral calcium supplements.
• D. Elevate the head of the bed to 45 degrees.

Correct answer: A

Rationale: The correct answer is to monitor the client's calcium levels for hypocalcemia. After a total thyroidectomy, there is a risk of accidental removal or damage to the parathyroid glands, leading to hypocalcemia. This complication can manifest within the first 24-48 hours post-op. Monitoring calcium levels is crucial to prevent serious complications such as tetany or seizures. While monitoring for respiratory distress is important, it is not the priority in this case. Administering oral calcium supplements should only be done based on the healthcare provider's prescription and after assessing the client's calcium levels. Elevating the head of the bed to 45 degrees is beneficial for respiratory function but is not the priority intervention for a client at risk for hypocalcemia post-thyroidectomy.

3. A client with heart failure has a prescription for digoxin. The nurse is aware that sufficient potassium should be included in the diet because hypokalemia in combination with this medication ____________.

• A. Can predispose to dysrhythmias
• B. May lead to oliguria
• C. May cause irritability and anxiety
• D. Sometimes alters consciousness

Correct answer: A

Rationale: The correct answer is A: Can predispose to dysrhythmias. Hypokalemia combined with digoxin increases the risk of dysrhythmias due to the potentiation of digoxin's effects on cardiac conduction. Choice B, May lead to oliguria, is incorrect because hypokalemia is not typically associated with oliguria. Choice C, May cause irritability and anxiety, is incorrect as these symptoms are more commonly associated with hypocalcemia. Choice D, Sometimes alters consciousness, is incorrect as altered consciousness is not a typical effect of hypokalemia combined with digoxin.

4. A client with hypothyroidism is prescribed levothyroxine. What instruction should the nurse provide?

• A. Take the medication in the morning before eating.
• B. Take the medication with a full glass of water.
• C. Take the medication with food to avoid nausea.
• D. Take the medication only when symptoms worsen.

Correct answer: A

Rationale: The correct answer is A: 'Take the medication in the morning before eating.' Levothyroxine should be taken on an empty stomach in the morning for optimal absorption. Choice B is incorrect because while taking medication with water is generally recommended, levothyroxine specifically needs to be taken on an empty stomach. Choice C is incorrect as taking levothyroxine with food can interfere with its absorption. Choice D is incorrect as levothyroxine should be taken regularly as prescribed, not only when symptoms worsen.

5. The nurse assesses a client one hour after starting a transfusion of packed red blood cells and determines that there are no indications of a transfusion reaction. What instruction should the nurse provide the UAP who is working with the nurse?

• A. Encourage the client to increase fluid intake
• B. Document the absence of reaction
• C. Notify the nurse if the client develops a fever
• D. Continue to measure the client's vital signs every thirty minutes until the transfusion is complete

Correct answer: D

Rationale: Monitoring vital signs throughout a transfusion is critical, as reactions can occur later in the process. The UAP should continue to check vital signs regularly to ensure that any delayed reaction is promptly detected. Encouraging the client to increase fluid intake (Choice A) is not necessary at this point, as the focus should be on monitoring. Documenting the absence of a reaction (Choice B) is important but not as crucial as ongoing vital sign monitoring. Notifying the nurse if the client develops a fever (Choice C) is relevant but should not be the UAP's primary responsibility during the transfusion.

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