Nursing Elites

1. The client is receiving vancomycin, and the nurse plans to draw blood for a peak and trough to determine... the best timing for these levels?

• A. Midway through administration of the IV dose and 30 minutes before the next
• B. Two hours after completion of the IV dose and 30 minutes before the next
• C. Two hours after completion of the IV dose and one hour before the next
• D. Immediately after completion of the IV dose and 30 minutes before

Correct answer: B

Rationale: To accurately determine peak and trough levels of vancomycin, blood should be drawn two hours after the completion of the IV dose and 30 minutes before the next dose. This timing allows for appropriate assessment of the drug levels in the body, ensuring accurate monitoring of therapeutic and toxic concentrations. Choice A is incorrect as drawing blood midway through administration does not provide an accurate peak level. Choice C is incorrect as drawing blood one hour before the next dose does not represent the trough level. Choice D is incorrect because drawing blood immediately after completion of the IV dose does not allow enough time for the drug to reach peak levels.

2. A client is receiving levothyroxine for hypothyroidism. The nurse should monitor the client for which potential side effect?

• A. Weight gain
• B. Dry skin
• C. Hair loss
• D. Hyperthermia

Correct answer: A

Rationale: Levothyroxine is a medication used to treat hypothyroidism by supplementing the body with thyroid hormone. If the dosage of levothyroxine is too high, it can cause symptoms of hyperthyroidism, including weight loss. Therefore, weight gain can be a potential side effect of levothyroxine if the dosage is excessive.

3. A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request?

• A. Determine if a take-home prescription for hydrocodone was provided and, if so, tell him to take one of them.
• B. Encourage him to wait until he is at home to take a medication that might impair reasoning.
• C. Give him a tablet from the hospital stock and tell him to wait until he is almost home to take it.
• D. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10.

Correct answer: D

Rationale: Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.

4. A client is prescribed an antibiotic for a urinary tract infection (UTI). What instruction should the practical nurse provide to the client to ensure the effectiveness of the medication?

• A. Take the medication with food.
• B. Increase fluid intake.
• C. Complete the full course of the medication.
• D. Avoid dairy products.

Correct answer: C

Rationale: The practical nurse should instruct the client to complete the full course of the antibiotic to ensure the infection is fully treated and to prevent the development of antibiotic resistance. Completing the full course of antibiotics helps to eradicate the infection completely and reduces the risk of bacteria developing resistance to the medication. Choices A, B, and D are not directly related to ensuring the effectiveness of the antibiotic. While taking medication with food or increasing fluid intake can be beneficial in general, the crucial instruction in this case is to complete the full course of the antibiotic.

5. A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines the client has been self-administering St. John's wort, an herbal preparation, on the advice of a friend. What information is most significant about this finding?

• A. Wort can decrease plasma concentration of Cyclospora
• B. Wort can decrease plasma concentration of Tacrolimus
• C. Wort can decrease plasma concentration of Cyclosporine
• D. Wort can decrease plasma concentration of Mycophenolate

Correct answer: C

Rationale: The most significant information about the client self-administering St. John's wort, an herbal preparation, is that it can decrease the plasma concentration of Cyclosporine. St. John's wort is known to reduce the efficacy of Cyclosporine, which is a common immunosuppressant drug used to prevent transplant rejection. Choices A, B, and D are incorrect because St. John's wort does not affect the plasma concentration of Cyclospora, Tacrolimus, or Mycophenolate.

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