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 asthma is receiving long-term glucocorticoid therapy. The nurse includes a risk for impaired skin integrity on the client's problem list. What is the rationale for including this problem?

• A. Abnormal fat deposits impair circulation
• B. Frequent diarrhea can lead to skin issues
• C. Thinned skin bruises easily
• D. Decreased serum glucose prolongs healing time

Correct answer: C

Rationale: The correct answer is C. Glucocorticoids can cause skin thinning, which increases the likelihood of bruising. Thinning of the skin due to glucocorticoid therapy makes it more fragile and prone to injury, such as bruising, even with minimal trauma. Choices A, B, and D are incorrect because abnormal fat deposits impairing circulation, frequent diarrhea causing skin issues, and decreased serum glucose prolonging healing time are not direct effects of glucocorticoid therapy on skin integrity.

3. 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.

4. A client with rheumatoid arthritis is prescribed methotrexate. The nurse should include which instruction 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: C

Rationale: The correct instruction for a client prescribed methotrexate is to avoid sunlight while taking this medication. Methotrexate can increase sensitivity to sunlight, leading to skin reactions. It is essential for clients to limit sun exposure and use protective measures like sunscreen and clothing coverage to prevent adverse effects. Choices A, B, and D are incorrect because avoiding alcohol, taking with food, and reporting signs of infection are not specific instructions related to methotrexate therapy.

5. A client with hypertension is prescribed lisinopril. The nurse should monitor for which potential side effect?

• A. Dry cough
• B. Hyperkalemia
• C. Hypernatremia
• D. Hyponatremia

Correct answer: A

Rationale: The correct answer is A: Dry cough. Lisinopril, an ACE inhibitor, is known to cause a persistent dry cough as a common side effect. Monitoring for this adverse effect is crucial because it may lead to non-adherence to the medication. Hyperkalemia (choice B) is a potential side effect of potassium-sparing diuretics, not ACE inhibitors like lisinopril. Hypernatremia (choice C) refers to elevated sodium levels and is not a common side effect of lisinopril. Hyponatremia (choice D) is a condition characterized by low sodium levels and is not a typical side effect of lisinopril. Therefore, the nurse should focus on assessing the client for a dry cough when taking lisinopril.

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