Nursing Elites

1. A client with a history of hypertension is prescribed lisinopril. Which potential side effect should the nurse monitor for?

• A. Hypokalemia
• B. Hyperglycemia
• C. Persistent cough
• D. Tachycardia

Correct answer: C

Rationale: The correct answer is C: Persistent cough. Lisinopril is an ACE inhibitor commonly associated with a persistent dry cough as a side effect. This cough is thought to result from increased bradykinin levels. Choices A, B, and D are incorrect. Hypokalemia is not a common side effect of lisinopril; in fact, it may lead to hyperkalemia. Hyperglycemia is not a typical side effect of lisinopril use. Tachycardia is also not a common side effect associated with ACE inhibitors like lisinopril.

2. The nurse is caring for a client with a diagnosis of major depressive disorder who has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the most important teaching point?

• A. Take the medication with food.
• B. Expect to see improvement within 24 hours.
• C. Avoid drinking grapefruit juice.
• D. Report any thoughts of self-harm immediately.

Correct answer: D

Rationale: The correct answer is D: 'Report any thoughts of self-harm immediately.' Clients prescribed SSRIs should be educated to report any thoughts of self-harm promptly, as these medications can initially increase suicidal ideation. Choice A is incorrect because SSRIs are usually taken on an empty stomach. Choice B is incorrect as it takes several weeks for SSRIs to reach their full effectiveness. Choice C is irrelevant to SSRI therapy.

3. A client with a diagnosis of hypothyroidism is prescribed levothyroxine (Synthroid). What is the most important instruction the nurse should provide?

• A. Take the medication in the morning on an empty stomach
• B. Take the medication with food
• C. Report any symptoms of hyperthyroidism
• D. Do not discontinue the medication abruptly

Correct answer: C

Rationale: The correct answer is C: 'Report any symptoms of hyperthyroidism.' Symptoms of hyperthyroidism, such as palpitations or tremors, may indicate an excessive dose of levothyroxine and should be reported to the healthcare provider for proper adjustment of the medication. Choice A is incorrect because levothyroxine is usually taken in the morning on an empty stomach to maximize absorption. Choice B is incorrect because taking levothyroxine with food can interfere with its absorption. Choice D is incorrect because discontinuing levothyroxine abruptly can lead to a worsening of hypothyroidism symptoms.

4. A client with a diagnosis of myocardial infarction (MI) is prescribed nitroglycerin. What is the primary action of this medication?

• A. Increases heart rate
• B. Lowers blood pressure
• C. Dilates coronary arteries
• D. Reduces myocardial oxygen demand

Correct answer: C

Rationale: The correct answer is C: Nitroglycerin dilates coronary arteries, improving blood flow to the heart muscle. This helps increase oxygen supply to the heart tissue. Option A, 'Increases heart rate,' is incorrect because nitroglycerin does not directly affect heart rate. Option B, 'Lowers blood pressure,' is also incorrect as while nitroglycerin can lower blood pressure, its primary action in the context of MI is related to coronary artery dilation. Option D, 'Reduces myocardial oxygen demand,' is not the primary action of nitroglycerin in the treatment of myocardial infarction; its main action is to increase oxygen supply by dilating coronary arteries.

5. A client with chronic obstructive pulmonary disease (COPD) is struggling to breathe. What should the nurse do first?

• A. Increase the oxygen flow rate according to the prescription
• B. Encourage the client to perform pursed-lip breathing
• C. Prepare for emergency intubation
• D. Assess the client's oxygen saturation and breath sounds

Correct answer: D

Rationale: The correct first action for a nurse when a client with COPD is struggling to breathe is to assess the client's oxygen saturation and breath sounds. This initial assessment is crucial in determining the severity of the client's condition and the appropriate intervention. Increasing the oxygen flow rate without proper assessment can potentially be harmful, as COPD clients have a risk of retaining carbon dioxide. Encouraging pursed-lip breathing can be beneficial but should come after assessing the client's current status. Emergency intubation is a drastic measure and should only be considered after a comprehensive assessment indicates the need for it.

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