Nursing Elites

1. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take this medication with food and plenty of water.
• B. I shall keep my appointment at the infusion center each week.
• C. I’ll limit my intake of green leafy vegetables while on this medication.
• D. I must not take this medication if I have an infection or am feeling ill.

Correct answer: B

Rationale: The correct answer is B. Temsirolimus, also known as Torisel, is administered as a weekly intravenous infusion. This medication blocks protein needed for cell division, inhibiting cell cycle progression. It is not taken orally, so there is no need to take it with food or water. Keeping the weekly infusion center appointment is crucial for the client to receive the prescribed treatment effectively. Choice A is incorrect as temsirolimus is not taken with food or water. Choice C is incorrect because there is no need to limit the intake of green leafy vegetables while on this medication. Choice D is incorrect as having an infection or feeling ill does not prohibit the use of temsirolimus.

2. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action?

• A. Administer the medication as ordered.
• B. Encourage the patient to drink more fluids.
• C. Hold the medication and request an order for serum BUN and creatinine.
• D. Request an order for serum electrolytes and administer the medication.

Correct answer: C

Rationale: The correct action is to hold the medication and request an order for serum BUN and creatinine. Thiazide diuretics, such as hydrochlorothiazide, are contraindicated in renal failure. In this case, the patient has oliguria, which is a reduced urine output, indicating potential renal insufficiency. Before administering the diuretic, it is crucial to evaluate the patient's renal function through serum BUN and creatinine levels. Encouraging the patient to drink more fluids (Choice B) may not address the underlying issue of renal function. Administering the medication as ordered (Choice A) without assessing renal function can be harmful. Requesting serum electrolytes and administering the medication (Choice D) overlooks the need for a specific evaluation of renal function in this scenario.

3. A client with elevated levels of antidiuretic hormone (ADH) triggers the release of this hormone due to which disorder?

• A. Pneumonia
• B. Dehydration
• C. Renal failure
• D. Edema

Correct answer: B

Rationale: Antidiuretic hormone (ADH) increases tubular permeability to water, causing more water absorption into the capillaries. ADH is released in response to a rising extracellular fluid osmolarity, such as in dehydration. Pneumonia, renal failure, and edema do not typically lead to the release of ADH. Pneumonia is an inflammatory lung condition, renal failure affects kidney function, and edema is the accumulation of excess fluid in the tissues, none of which directly stimulate the release of ADH.

4. A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for

• A. hyperkalemia.
• B. hypermagnesemia.
• C. hypocalcemia.
• D. hypoglycemia.

Correct answer: A

Rationale: The correct answer is A: hyperkalemia. Spironolactone is a potassium-sparing diuretic commonly used in heart failure management. One of the major side effects of spironolactone is hyperkalemia, which is an elevated level of potassium in the blood. Monitoring for hyperkalemia is crucial as it can lead to serious cardiac arrhythmias. Choices B, C, and D are incorrect. Hypermagnesemia (choice B) is not typically associated with spironolactone use. Hypocalcemia (choice C) and hypoglycemia (choice D) are also not directly linked to the use of spironolactone in heart failure treatment.

5. After checking the client’s gag reflex following an esophagogastroduodenoscopy (EGD), which action should the nurse take?

• A. Taking the client’s vital signs
• B. Giving the client a drink of water
• C. Monitoring the client for a sore throat
• D. Being alert to complaints of heartburn

Correct answer: A

Rationale: After an esophagogastroduodenoscopy (EGD), the nurse's priority is to assess the client's airway by checking the gag reflex. Once this assessment is done, the next step is to take the client's vital signs to monitor for any signs of complications such as bleeding or changes in respiratory status. Giving the client water immediately after the procedure may not be appropriate, as the client may still have a compromised gag reflex and is at risk for aspiration. Monitoring for a sore throat is important but not the immediate priority post-procedure. Being alert to complaints of heartburn is relevant for assessing the client's symptoms but is not the priority immediately after checking the gag reflex.

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