Nursing Elites

1. A client who is recovering from an appendectomy is receiving narcotics. Earlier, the nurse witnessed the client's family pushing the pain pump. What should the nurse implement?

• A. Check the client's level of consciousness
• B. Instruct the family not to push the button
• C. Stop the client's basal infusion
• D. Administer a narcotic reversal medication

Correct answer: B

Rationale: Instructing the family not to push the button is necessary to prevent the client from receiving an excessive amount of narcotics, ensuring the safe and appropriate use of the pain pump. Checking the client's level of consciousness may not address the issue of family members pushing the button. Stopping the client's basal infusion is not indicated unless there are specific medical reasons for doing so. Administering a narcotic reversal medication is not necessary at this point as the issue lies with inappropriate use rather than an overdose.

2. A client is prescribed nitroglycerin sublingual tablets. The practical nurse should reinforce which instruction?

• A. Store the tablets in a cool, dry place.
• B. Take one tablet every 5 minutes until pain is relieved, up to three tablets.
• C. Swallow the tablets whole.
• D. Chew the tablets for faster relief.

Correct answer: A

Rationale: Nitroglycerin sublingual tablets are sensitive to heat and moisture, so they should be stored in a cool, dry place to maintain their efficacy. Storing them in a cool, dry place helps prevent degradation of the medication. Choice B is incorrect because nitroglycerin tablets should be taken as directed by the healthcare provider to avoid potential overdose or adverse effects. Choice C is incorrect because sublingual tablets should be placed under the tongue to dissolve and be absorbed, not swallowed, to ensure their quick action. Choice D is incorrect because sublingual tablets should not be chewed; they are meant to be absorbed through the tissues under the tongue, and chewing them may alter their effectiveness.

3. A client with a history of hypertension is prescribed amlodipine. The nurse should monitor the client for which potential adverse effect?

• A. Peripheral edema
• B. Tachycardia
• C. Bradycardia
• D. Increased appetite

Correct answer: A

Rationale: Corrected Rationale: Amlodipine is a calcium channel blocker commonly associated with causing peripheral edema as an adverse effect. The nurse should monitor the client for signs of swelling, particularly in the lower extremities, as it may indicate a need for dosage adjustment or further evaluation. Choices B, C, and D are incorrect as amlodipine is not known to cause tachycardia, bradycardia, or increased appetite as adverse effects.

4. Which action should be taken to assess for analgesic tolerance in a client who is unable to communicate?

• A. Review the client's laboratory values for changes in peak and trough levels of the analgesic
• B. Prolong the interval between analgesic medication doses and monitor the client's vital signs
• C. Observe the client for the presence of pain behaviors before the next analgesic dose is due
• D. Ask family members to report behaviors suggesting that the client's pain has returned

Correct answer: C

Rationale: In clients who are unable to communicate, observing for pain behaviors is crucial in assessing analgesic tolerance. Changes in pain behaviors can indicate if the current analgesic regimen is effective or if tolerance has developed. Therefore, closely observing the client for pain behaviors before the next analgesic dose helps healthcare providers evaluate the client's response to pain management. Reviewing laboratory values may not directly reflect analgesic tolerance. Prolonging the interval between doses and monitoring vital signs may not provide direct information on analgesic tolerance. Relying solely on family members to report pain behaviors may not be as accurate or immediate as observing the client directly.

5. A client undergoing hemodialysis for chronic kidney disease is taking the medication erythropoietin. The nurse should reinforce instructions to explain for which reason this medication is prescribed?

• A. This drug prevents infections associated with dialysis.
• B. This drug prevents deep vein thrombosis in older clients.
• C. This drug helps stimulate the production of red blood cells.
• D. This drug helps balance the level of phosphorus in the body.

Correct answer: C

Rationale: Erythropoietin is prescribed to stimulate the production of red blood cells. Clients undergoing hemodialysis often develop anemia due to end-stage renal disease. Erythropoietin helps correct this anemia by stimulating red blood cell production. It is not used to prevent infections associated with dialysis, prevent deep vein thrombosis, or balance phosphorus levels in the body.

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