Nursing Elites

1. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

2. When providing dietary instructions to a client with cirrhosis, which dietary restriction is important for the nurse to emphasize?

• A. Low-protein diet
• B. Low-sodium diet
• C. High-fiber diet
• D. High-calcium diet

Correct answer: B

Rationale: A low-sodium diet is crucial for clients with cirrhosis to manage fluid retention and ascites. Excessive sodium intake can worsen fluid accumulation in the body, leading to complications. By restricting sodium intake, the client can help reduce fluid retention and maintain better overall health. Therefore, emphasizing a low-sodium diet is essential in the dietary management of cirrhosis. Choices A, C, and D are not the primary focus for cirrhosis management. While protein restriction may be necessary in advanced stages of liver disease, it is not the main dietary concern in cirrhosis. High-fiber and high-calcium diets are generally beneficial for overall health but are not specifically emphasized in cirrhosis management.

3. What side effect should be monitored for in a patient with chronic heart failure taking spironolactone?

• A. Hypokalemia
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypernatremia

Correct answer: B

Rationale: The correct answer is B: Hyperkalemia. Spironolactone is a potassium-sparing diuretic commonly used in patients with heart failure. One of the potential side effects of spironolactone therapy is hyperkalemia, which is an elevated level of potassium in the blood. Hyperkalemia can lead to serious cardiac arrhythmias, making it crucial for healthcare providers to monitor potassium levels closely. Choices A, C, and D are incorrect because hypokalemia (low potassium levels), hyponatremia (low sodium levels), and hypernatremia (high sodium levels) are not typically associated with spironolactone use in patients with chronic heart failure.

4. A client with chronic renal failure is prescribed epoetin alfa (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Decreased blood pressure.
• C. Improved hemoglobin levels.
• D. Stable potassium levels.

Correct answer: C

Rationale: Epoetin alfa is a medication that stimulates red blood cell production. Therefore, in a client with chronic renal failure, an effective outcome of epoetin alfa therapy would be an improvement in hemoglobin levels. This indicates that the medication is working as intended by addressing anemia, a common complication of chronic renal failure. Increased urine output (choice A) is not directly related to the action of epoetin alfa. Decreased blood pressure (choice B) is not a primary expected outcome of epoetin alfa therapy. Stable potassium levels (choice D) are important but not a direct indicator of the effectiveness of epoetin alfa in this context.

5. A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What is the primary purpose of this medication?

• A. Increase thyroid hormone production
• B. Suppress thyroid hormone production
• C. Enhance iodine absorption
• D. Stimulate the thyroid gland

Correct answer: B

Rationale: Propylthiouracil (PTU) is a medication used to treat hyperthyroidism by suppressing the production of thyroid hormones. It works by inhibiting the enzyme responsible for the synthesis of thyroid hormones, thereby reducing their levels in the body. This helps to alleviate the symptoms of hyperthyroidism and restore thyroid hormone levels to normal range.

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