Nursing Elites

1. Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client:

• A. Cut the dose in half.
• B. Discontinue the medication.
• C. Take the medication with food.
• D. Contact the healthcare provider (HCP).

Correct answer: C

Rationale: Isosorbide mononitrate can cause headaches, which usually disappear during continued therapy. Taking the medication with food or meals can help alleviate the headache. It is important to recommend this approach before considering dose adjustments or discontinuation of the medication. Contacting the healthcare provider would be necessary if the headache persists despite taking the medication with food.

2. A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:

• A. Hypercalcemia
• B. Peripheral neuritis
• C. Small blood vessel spasm
• D. Impaired peripheral circulation

Correct answer: B

Rationale: The client's symptoms of numbness, paresthesias, and tingling in the extremities indicate peripheral neuritis, a common side effect of isoniazid (INH). This condition can be managed by supplementing with pyridoxine (vitamin B6) to minimize the symptoms.

3. A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?

• A. Monitoring the leukocyte count for 2 days after the infusion
• B. Checking the frequency and consistency of bowel movements
• C. Checking serum liver enzyme levels before and after the infusion
• D. Carrying out a Hematest on gastric fluids after the infusion is completed

Correct answer: B

Rationale: To monitor the effectiveness of infliximab (Remicade) treatment in a client with Crohn's disease, the nurse should observe the frequency and consistency of bowel movements. Infliximab is an immunomodulator that works to reduce inflammation in the colon, leading to improvements in bowel symptoms such as frequency and consistency. Monitoring these bowel patterns can provide valuable insight into the response to the medication and the overall management of Crohn's disease. Checking the leukocyte count (Choice A) is not specific to monitoring the effectiveness of infliximab for Crohn's disease. Checking serum liver enzyme levels (Choice C) may be important for liver function but does not directly monitor the effectiveness of infliximab. Carrying out a Hematest on gastric fluids (Choice D) is not relevant to monitoring the effectiveness of infliximab in Crohn's disease.

4. A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness?

• A. Lung sounds
• B. Blood pressure
• C. Blood ammonia level
• D. Serum potassium level

Correct answer: C

Rationale: In portosystemic encephalopathy, the liver's ability to detoxify ammonia is impaired, leading to elevated blood ammonia levels, which can cause neurological symptoms such as encephalopathy. Lactulose is given to reduce ammonia levels by promoting its excretion through the bowel. Therefore, assessing the blood ammonia level is crucial to determine the effectiveness of lactulose therapy in managing portosystemic encephalopathy.

5. A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication?

• A. Diarrhea
• B. Weakness
• C. Headache
• D. Constipation

Correct answer: D

Rationale: Constipation is a common side effect of iron supplements such as ferrous sulfate. Iron can cause constipation by slowing down the movement of the digestive system and hardening the stool. Patients should be advised to increase their fluid intake, dietary fiber, and physical activity to help alleviate this side effect. Diarrhea (Choice A) is not a common side effect associated with ferrous sulfate. Weakness (Choice B) and headache (Choice C) are not typically linked to this medication.

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