Nursing Elites

1. Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin:

• A. 1 hour after each meal
• B. Once daily, at the same time each day
• C. 15 minutes before breakfast, lunch, and dinner
• D. Before each meal, based on the blood glucose level

Correct answer: B

Rationale: Insulin glargine (Lantus) is a long-acting insulin with a duration of action of approximately 24 hours, making it suitable for once-daily dosing at the same time each day. This regimen helps maintain consistent blood glucose levels and simplifies the client's treatment routine. Taking insulin glargine once daily provides basal insulin coverage throughout the day, reducing the risk of hypoglycemia compared to short-acting insulins that are taken before each meal.

2. A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy?

• A. Adventitious breath sounds
• B. Temperature of 99.4°F orally
• C. Blood pressure of 198/110 mm Hg
• D. Respiratory rate of 28 breaths/min

Correct answer: C

Rationale: The correct answer is C. Streptokinase therapy is contraindicated in severe uncontrolled hypertension due to the risk of cerebral hemorrhage. A blood pressure of 198/110 mm Hg indicates severe hypertension, which needs to be addressed before initiating streptokinase to prevent potential complications.

3. The healthcare provider is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the healthcare provider specifically note as a result of the massive cell destruction that occurred from the chemotherapy?

• A. Anemia
• B. Decreased platelets
• C. Increased uric acid level
• D. Decreased leukocyte count

Correct answer: C

Rationale: Following chemotherapy for leukemias and lymphomas, hyperuricemia is common due to the massive cell kill. Chemotherapy leads to the rapid destruction of cancer cells, releasing large amounts of nucleic acids, which are broken down into uric acid. Monitoring and managing uric acid levels are crucial to prevent complications such as renal damage and gout.

4. The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?

• A. Hyperventilation
• B. Elevated blood pressure
• C. Local pain at the burn site
• D. Local rash at the burn site

Correct answer: A

Rationale: Hyperventilation is an indication of a systemic effect of mafenide acetate (Sulfamylon) due to its potential to cause acidosis by suppressing renal excretion of acid. If hyperventilation occurs, the medication should be discontinued to prevent further complications.

5. A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to:

• A. Count the radial and carotid pulses every morning.
• B. Check the blood pressure every morning and evening.
• C. Stop taking the medication if the pulse is higher than 100 beats per minute.
• D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

Correct answer: D

Rationale: When taking digoxin, monitoring the pulse rate is essential due to its potential effects on heart rate. Digoxin can lead to bradycardia, where the pulse rate drops significantly. Withholding the medication and promptly contacting the healthcare provider if the pulse falls below 60 beats per minute is crucial to prevent severe complications and ensure appropriate management. Choices A, B, and C are incorrect because counting radial and carotid pulses, checking blood pressure, or stopping the medication based on a pulse rate higher than 100 beats per minute are not the primary monitoring parameters for a client taking digoxin.

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