Nursing Elites

1. Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which of the following food items?

• A. Milk
• B. Water
• C. Apple juice
• D. Orange juice

Correct answer: D

Rationale: Iron absorption is enhanced by the presence of vitamin C. Orange juice is a good source of vitamin C, which can improve the absorption of iron when taken together. Therefore, administering iron supplements with orange juice is the best choice to optimize iron absorption for the child.

2. The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select one that doesn't apply.

• A. Diarrhea can occur secondary to the metformin.
• B. The repaglinide is not taken if a meal is skipped.
• C. The repaglinide is taken 30 minutes before eating.
• D. Nausea and vomiting

Correct answer: D

Rationale: Repaglinide is a rapid-acting oral hypoglycemic that should be taken before meals and withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide, so carrying a simple sugar is essential. Metformin decreases hepatic glucose production and can cause diarrhea. Muscle pain may occur as an adverse effect and should be reported to the HCP.

3. Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?

• A. Discontinuation of warfarin sodium (Coumadin)
• B. A decrease in the warfarin sodium (Coumadin) dosage
• C. An increase in the warfarin sodium (Coumadin) dosage
• D. A decrease in the usual dose of nalidixic acid (NegGram)

Correct answer: B

Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma proteins. When an oral anticoagulant, like warfarin sodium (Coumadin), is combined with nalidixic acid, a decrease in the anticoagulant dosage may be necessary to avoid excessive anticoagulation and potential bleeding risks. Therefore, the correct action for the nurse to anticipate in this situation is a decrease in the warfarin sodium (Coumadin) dosage. Choice A is incorrect because discontinuing warfarin sodium abruptly can lead to thrombosis or embolism. Choice C is incorrect as increasing the warfarin sodium dosage can potentiate the anticoagulant effect, leading to bleeding complications. Choice D is incorrect as reducing the dose of nalidixic acid would not directly address the interaction with warfarin sodium.

4. Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client:

• A. To take the medication after meals
• B. To take the medication before meals
• C. To discontinue the medication if a headache occurs
• D. That a reddish-orange discoloration of the urine may occur

Correct answer: D

Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse should also educate the client that this discoloration can stain fabric. It is recommended to take the medication after meals to reduce the possibility of gastrointestinal upset. While a headache is an occasional side effect of the medication, it does not warrant discontinuation of the medication.

5. The clinic nurse is reviewing a teaching plan for a client receiving antineoplastic medication. When implementing the plan, the nurse should advise the client:

• A. To take aspirin (acetylsalicylic acid) as needed for a headache
• B. To avoid drinking beverages containing alcohol
• C. To consult with healthcare providers (HCPs) before receiving immunizations
• D. That it is necessary to consult HCPs before receiving a flu vaccine at the local health fair

Correct answer: C

Rationale: The correct advice for a client receiving antineoplastic medication is to consult with healthcare providers (HCPs) before receiving immunizations. Antineoplastic medications can lower the body's resistance, making it crucial to seek guidance from healthcare providers to prevent potential complications that may arise due to the medication's impact on the immune system. Choices A, B, and D are incorrect because taking aspirin for a headache, avoiding alcohol, and consulting only before a flu vaccine at a local health fair do not directly address the specific risk related to antineoplastic medications and immunizations.

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