Nursing Elites

1. A healthcare professional in an emergency unit is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. Which of the following findings is indicative of this condition?

• A. Insidious onset of painless loss of vision
• B. Gradual reduction in peripheral vision
• C. Severe pain around the eyes
• D. Intraocular pressure 12 mm Hg

Correct answer: C

Rationale: Severe pain around the eyes that radiates over the face is a classic symptom of acute angle-closure glaucoma. This intense pain is often associated with other symptoms such as blurred vision, halos around lights, redness in the eye, and sometimes nausea and vomiting. Immediate medical attention is required to prevent permanent vision loss. Choices A, B, and D are incorrect. Insidious onset of painless loss of vision is more indicative of conditions like macular degeneration. Gradual reduction in peripheral vision is commonly seen in conditions like open-angle glaucoma. An intraocular pressure of 12 mm Hg is within the normal range and is not typical of angle-closure glaucoma.

2. When administering Phenytoin, what should you monitor?

• A. Behavior
• B. Therapeutic blood levels
• C. For signs of Stevens-Johnson syndrome
• D. All of the above

Correct answer: D

Rationale: When administering Phenytoin, monitoring the patient's behavior is important to assess for any changes that may indicate adverse effects. Monitoring therapeutic blood levels helps ensure the medication is within the effective range and not causing toxicity. Additionally, being vigilant for signs of Stevens-Johnson syndrome, a severe skin reaction associated with Phenytoin use, is crucial for early detection and intervention. Therefore, monitoring behavior, therapeutic blood levels, and for signs of Stevens-Johnson syndrome are all essential when administering Phenytoin.

3. A client has a new prescription for Prednisone. Which of the following instructions should be included in the discharge teaching?

• A. Increase your intake of potassium-rich foods.
• B. Avoid consuming grapefruit juice.
• C. Take this medication with food.
• D. Decrease your intake of sodium-rich foods.

Correct answer: A

Rationale: The correct answer is A: "Increase your intake of potassium-rich foods." Prednisone is associated with potassium depletion, making it important for clients to increase their intake of potassium-rich foods to prevent potential imbalances. Foods such as bananas, oranges, and spinach are good sources of potassium. Choice B, "Avoid consuming grapefruit juice," is not directly related to Prednisone use. Choice C, "Take this medication with food," is a general instruction for many medications but not specific to Prednisone. Choice D, "Decrease your intake of sodium-rich foods," is not directly related to Prednisone's side effects.

4. A client prescribed Isosorbide Mononitrate for chronic stable Angina develops reflex tachycardia. Which of the following medications should the nurse expect to administer?

• A. Furosemide
• B. Captopril
• C. Ranolazine
• D. Metoprolol

Correct answer: D

Rationale: Metoprolol, a beta-adrenergic blocker, is commonly used to treat hypertension and stable angina pectoris. It is often prescribed to decrease heart rate in clients who develop tachycardia, such as in the case of reflex tachycardia induced by Isosorbide Mononitrate, making it the appropriate choice in this scenario. Furosemide (Choice A) is a loop diuretic used for conditions like heart failure and edema, not for reflex tachycardia. Captopril (Choice B) is an ACE inhibitor primarily used for hypertension and heart failure, not for reflex tachycardia. Ranolazine (Choice C) is used for chronic angina but does not specifically address reflex tachycardia.

5. A client is prescribed an IM dose of penicillin. She reports developing a rash after taking penicillin 3 years ago. What action should the healthcare professional take?

• A. Administer the prescribed dose.
• B. Withhold the medication.
• C. Ask the provider to change the prescription to an oral form.
• D. Administer an oral antihistamine at the same time.

Correct answer: B

Rationale: The healthcare professional should withhold the medication and notify the provider of the client's previous reaction to penicillin. It is crucial to report any past allergic reactions to medications, as this information guides the provider in prescribing a safe alternative. Administering the prescribed dose without considering the client's history of developing a rash can lead to potentially severe adverse reactions. Changing the prescription to an oral form or administering an oral antihistamine does not address the risk of an allergic reaction to penicillin in this case.

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