Nursing Elites

1. During a unit of whole blood transfusion, a client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The healthcare professional should anticipate a prescription for which of the following medications?

• A. Epinephrine
• B. Lorazepam
• C. Furosemide
• D. Diphenhydramine

Correct answer: C

Rationale: In the scenario described, the client is exhibiting signs of fluid overload, which can occur during blood transfusion. Furosemide, a loop diuretic, is commonly prescribed in such situations to help relieve manifestations of circulatory overload by promoting diuresis and reducing fluid volume. Therefore, the correct choice is C - Furosemide. Epinephrine (Choice A) is not indicated for fluid overload but for severe allergic reactions. Lorazepam (Choice B) is a benzodiazepine used for anxiety or sedation, not for fluid overload. Diphenhydramine (Choice D) is an antihistamine often used for allergic reactions, not for fluid overload.

2. A client has a new prescription for Levodopa/Carbidopa for Parkinson's disease. Which of the following instructions should the nurse include?

• A. Increase intake of protein-rich foods.
• B. Expect muscle twitching to occur.
• C. Take this medication with food.
• D. Anticipate relief of manifestations in 24 hours.

Correct answer: C

Rationale: The correct instruction the nurse should include is to take Levodopa/Carbidopa with food. Taking this medication with food helps reduce gastrointestinal side effects. Instructing the client to take the medication with food promotes better tolerance and absorption of the drug. Choice A is incorrect because increasing protein-rich foods is not specifically related to the administration of this medication. Choice B is incorrect as muscle twitching is not a common side effect of Levodopa/Carbidopa. Choice D is incorrect because relief of manifestations may take longer than 24 hours to occur.

3. A client has a new prescription for Prednisone. Which of the following laboratory values should be monitored by the healthcare provider?

• A. Serum potassium
• B. Serum calcium
• C. Serum sodium
• D. Serum glucose

Correct answer: D

Rationale: When a client is prescribed Prednisone, monitoring serum glucose levels is essential. Prednisone, a corticosteroid, can lead to hyperglycemia. Therefore, regular monitoring of serum glucose helps in detecting and managing any potential hyperglycemic effects of the medication. Monitoring serum potassium, calcium, or sodium is not typically required when a client is on Prednisone unless there are specific risk factors or concerns related to these electrolytes.

4. A healthcare professional is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the healthcare professional adjust the manual IV infusion to deliver?

• A. 22 gtt/min
• B. 24 gtt/min
• C. 20 gtt/min
• D. 18 gtt/min

Correct answer: A

Rationale: To calculate the flow rate, use the formula: (Volume in mL x Drop factor) / Time in minutes = Flow rate in gtt/min. In this case, (100 mL x 10 gtt/mL) / 45 min = 22 gtt/min. Thus, the healthcare professional should adjust the manual IV infusion to deliver 22 gtt/min. Choice B, 24 gtt/min, is incorrect because it miscalculates the flow rate. Choices C and D, 20 gtt/min and 18 gtt/min, are also incorrect as they do not accurately calculate the flow rate based on the given information.

5. A client received IV Verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min, and blood pressure is 74/44 mm Hg. The nurse should anticipate a prescription for which of the following IV medications?

• A. Calcium gluconate
• B. Sodium bicarbonate
• C. Potassium chloride
• D. Magnesium sulfate

Correct answer: A

Rationale: In this situation, where the client's blood pressure is significantly lowered due to Verapamil administration, the nurse should anticipate a prescription for Calcium gluconate. Calcium gluconate is used to reverse severe hypotension caused by Verapamil. It should be given slowly intravenously as it counteracts the vasodilation caused by Verapamil, helping to normalize blood pressure levels. Sodium bicarbonate is not indicated for low blood pressure. Potassium chloride and magnesium sulfate are not the appropriate choices to address hypotension caused by Verapamil.

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