Nursing Elites

1. A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instructions?

• A. I need to watch for signs of infection.
• B. I need to discontinue the medication after 14 days of use.
• C. I can take the medication with meals to minimize nausea.
• D. I need to call the health care provider (HCP) if more than one dose is missed.

Correct answer: B

Rationale: Azathioprine is an immunosuppressant taken for life. Discontinuing the medication after 14 days is incorrect.

2. The healthcare provider is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the healthcare provider specifically note as a result of the massive cell destruction that occurred from the chemotherapy?

• A. Anemia
• B. Decreased platelets
• C. Increased uric acid level
• D. Decreased leukocyte count

Correct answer: C

Rationale: Following chemotherapy for leukemias and lymphomas, hyperuricemia is common due to the massive cell kill. Chemotherapy leads to the rapid destruction of cancer cells, releasing large amounts of nucleic acids, which are broken down into uric acid. Monitoring and managing uric acid levels are crucial to prevent complications such as renal damage and gout.

3. When reviewing laboratory results for a client receiving tacrolimus (Prograf), which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication?

• A. Blood glucose of 200 mg/dL
• B. Potassium level of 3.8 mEq/L
• C. Platelet count of 300,000 cells/mm³
• D. White blood cell count of 6000 cells/mm³

Correct answer: A

Rationale: An elevated blood glucose level of 200 mg/dL indicates an adverse effect of tacrolimus. This finding suggests hyperglycemia, which is a known adverse effect of the medication. Other potential adverse effects of tacrolimus include neurotoxicity and hypertension. Monitoring blood glucose levels is crucial to detect and manage this adverse effect promptly. Choices B, C, and D are not directly associated with adverse effects of tacrolimus. Potassium, platelet count, and white blood cell count are important parameters to monitor for other reasons but not specifically for detecting adverse effects of tacrolimus.

4. A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is experiencing a therapeutic effect from this medication?

• A. Abdominal pain
• B. Reduction in steatorrhea
• C. Hematest-negative stools
• D. Regular bowel movements

Correct answer: D

Rationale: The therapeutic effect of docusate sodium (Colace) is to soften stools and promote regular bowel movements, making option D the correct choice. Monitoring for regular bowel movements would indicate that the medication is working as intended by relieving or preventing constipation. Options A, B, and C are not directly related to the therapeutic effect of docusate sodium. Abdominal pain (option A) is a symptom that might indicate a problem rather than a therapeutic effect. Reduction in steatorrhea (option B) and Hematest-negative stools (option C) are not specific outcomes associated with docusate sodium.

5. A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?

• A. Constipation and bloating might be a problem.
• B. I'll continue to watch my diet and reduce my fats.
• C. Walking a mile each day will help the whole process.
• D. I'll continue my nicotinic acid from the health food store.

Correct answer: D

Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

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