Nursing Elites

1. Twenty-four hours after starting to take oral penicillin for strep throat, a client calls the nurse to report the onset of a rash on the chest. What action should the nurse implement?

• A. Instruct the client to discontinue the penicillin immediately
• B. Instruct the client regarding the use of topical analgesic cream PRN
• C. Question the client about any other related symptoms
• D. Reinforce the need to take all doses of the penicillin

Correct answer: A

Rationale: In this scenario, the client has developed a rash after starting oral penicillin, which can indicate an allergic reaction. It is crucial for the nurse to instruct the client to discontinue the penicillin immediately. Continuing the medication can potentially lead to severe allergic reactions. Instructing about topical analgesic cream or questioning about other related symptoms may delay appropriate action in case of a severe allergic reaction. Reinforcing the need to complete all doses is not appropriate when an allergic reaction is suspected, as safety takes precedence over completing the antibiotic course.

2. A client diagnosed with multiple sclerosis self-administers beta-1 interferon subcutaneously

• A. Explain to the client that the medication dose may need to be increased
• B. Instruct the client to withhold the drug until the next exacerbation
• C. Advise the client to consult the healthcare provider as soon as possible
• D. Encourage the client to continue taking the medication

Correct answer: D

Rationale: Encouraging the client to continue taking the medication is crucial in the management of multiple sclerosis. Beta-1 interferon is a disease-modifying drug used to reduce the frequency and severity of relapses in multiple sclerosis. Discontinuing the medication without medical advice can lead to disease exacerbation. It is essential for the client to maintain regular dosing to achieve optimal therapeutic effects and disease control.

3. A postoperative client has a prescription for ketorolac 30mg IV q6h. Which response demonstrates that therapeutic levels of the medication have been achieved?

• A. Observe wound drainage for a change in appearance
• B. Assess the client's calves for inflammation
• C. Perform a pain assessment using a numeric scale
• D. Measure the client's intake and output

Correct answer: C

Rationale: The correct response is to perform a pain assessment using a numeric scale. Ketorolac is an NSAID prescribed for pain relief. Monitoring pain levels is crucial to evaluate the therapeutic effectiveness of the medication. Pain assessment helps determine if the medication is providing adequate pain relief, indicating that therapeutic levels have been achieved.

4. A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?

• A. The client is experiencing vision and hearing loss.
• B. The client has an erection lasting longer than 4 hours.
• C. The client is complaining of nasal congestion.
• D. The client is complaining of feeling flushed.

Correct answer: A

Rationale: The correct answer is A. If a client prescribed sildenafil for pulmonary hypertension experiences vision and/or hearing loss or an erection lasting more than 4 hours, the practical nurse should instruct the client to discontinue the medication immediately and notify the health care provider. These symptoms could indicate serious side effects that require prompt medical attention to prevent complications. Choices B, C, and D are incorrect because an erection lasting more than 2 hours (not 4 hours as stated in choice B) is a critical adverse effect that warrants immediate medical attention. Nasal congestion (choice C) and feeling flushed (choice D) are common side effects of sildenafil and typically do not necessitate immediate discontinuation of the medication or emergency intervention.

5. A client receiving enalapril reports a persistent dry cough. The nurse should explain that this side effect is related to which medication action?

• A. It reduces the production of angiotensin II.
• B. It increases the production of angiotensin II.
• C. It causes increased production of bradykinin.
• D. It increases the production of aldosterone.

Correct answer: C

Rationale: The correct answer is C. Enalapril, an ACE inhibitor, inhibits the conversion of angiotensin I to angiotensin II, leading to increased levels of bradykinin. The accumulation of bradykinin is responsible for the persistent dry cough associated with ACE inhibitors like enalapril. Choices A, B, and D are incorrect because enalapril does not directly affect the production of angiotensin II or aldosterone. Instead, it primarily impacts the renin-angiotensin-aldosterone system by inhibiting the conversion of angiotensin I to angiotensin II, leading to bradykinin accumulation.

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