Nursing Elites

1. The healthcare provider has prescribed an influenza vaccine for a 74-year-old client before discharge. Which client condition would prompt the practical nurse to consult with the charge nurse rather than administer the vaccine?

• A. History of congestive heart failure
• B. History of an egg allergy
• C. History of pneumococcal vaccination
• D. History of end-stage renal disease

Correct answer: B

Rationale: The correct answer is B: History of an egg allergy. The influenza vaccine may contain a small amount of egg protein. According to the CDC, individuals with a severe allergy to any component of the vaccine, including egg protein, should not receive the influenza vaccine. Therefore, if the client has a history of an allergy to eggs, the practical nurse should not administer the vaccine and consult with the charge nurse for further guidance, as it is a contraindication. The other conditions listed do not require consultation before administering the influenza vaccine.

2. A client with type 2 diabetes is prescribed metformin. What instruction should the practical nurse (PN) include in the client's teaching plan?

• A. Take the medication with meals to decrease gastrointestinal upset.
• B. Take the medication with a full glass of water.
• C. Avoid alcohol while taking the medication.
• D. Take the medication with meals to increase absorption.

Correct answer: B

Rationale: The correct instruction for a client prescribed metformin is to take the medication with a full glass of water. This helps ensure proper ingestion and absorption of the medication. While taking metformin with meals can help reduce gastrointestinal side effects, the primary focus should be on adequate hydration and absorption by taking it with water. Avoiding alcohol while taking metformin is also important as alcohol can increase the risk of lactic acidosis when combined with metformin. Taking the medication with meals to increase absorption is incorrect as metformin should be taken with food to reduce gastrointestinal upset, not to increase absorption.

3. A client with a diagnosis of generalized anxiety disorder is prescribed hydroxyzine. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Hydroxyzine is known to cause drowsiness, so clients should be advised to avoid activities like driving until they understand how the medication affects them. Choices B, C, and D are incorrect because dry mouth, nausea, and headache are not commonly associated with hydroxyzine use. It is crucial for the client to be aware of the potential drowsiness to ensure their safety and well-being while taking this medication.

4. A client with hypertension is prescribed valsartan. The nurse should monitor the client for which potential side effect?

• A. Hypotension
• B. Tachycardia
• C. Hyperglycemia
• D. Hyponatremia

Correct answer: A

Rationale: The correct answer is A: Hypotension. Valsartan is an angiotensin II receptor blocker that can cause hypotension as a side effect by dilating blood vessels. Monitoring blood pressure is crucial to prevent complications related to low blood pressure. Choice B, Tachycardia, is incorrect because valsartan typically does not cause an increase in heart rate. Choice C, Hyperglycemia, is not a common side effect of valsartan. Choice D, Hyponatremia, is also unlikely with valsartan use.

5. A client with rheumatoid arthritis is prescribed leflunomide. What instruction should the nurse include in the client's teaching plan?

• A. Avoid alcohol while taking this medication.
• B. Take this medication with food to decrease gastrointestinal upset.
• C. Avoid sunlight while taking this medication.
• D. Report any signs of infection to the healthcare provider.

Correct answer: A

Rationale: Leflunomide can increase sensitivity to sunlight. While it is important to avoid excessive sun exposure, the critical instruction for the client is to avoid alcohol while taking this medication. Alcohol can potentiate the hepatotoxic effects of leflunomide, making it crucial for the client to abstain from alcohol consumption to prevent liver damage.

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