Nursing Elites

1. A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication?

• A. Temperature
• B. Respirations
• C. Blood pressure
• D. Radial pulse rate

Correct answer: C

Rationale: The correct answer is checking the client's blood pressure (C) before administering another nitroglycerin tablet. Nitroglycerin can cause hypotension, and monitoring blood pressure is crucial to prevent a sudden drop in blood pressure, especially when giving another dose of nitroglycerin.

2. Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?

• A. Discontinuation of warfarin sodium (Coumadin)
• B. A decrease in the warfarin sodium (Coumadin) dosage
• C. An increase in the warfarin sodium (Coumadin) dosage
• D. A decrease in the usual dose of nalidixic acid (NegGram)

Correct answer: B

Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma proteins. When an oral anticoagulant, like warfarin sodium (Coumadin), is combined with nalidixic acid, a decrease in the anticoagulant dosage may be necessary to avoid excessive anticoagulation and potential bleeding risks. Therefore, the correct action for the nurse to anticipate in this situation is a decrease in the warfarin sodium (Coumadin) dosage. Choice A is incorrect because discontinuing warfarin sodium abruptly can lead to thrombosis or embolism. Choice C is incorrect as increasing the warfarin sodium dosage can potentiate the anticoagulant effect, leading to bleeding complications. Choice D is incorrect as reducing the dose of nalidixic acid would not directly address the interaction with warfarin sodium.

3. Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?

• A. Decreased urinary output
• B. Decreased blood pressure
• C. Decreased peripheral edema
• D. Decreased blood glucose level

Correct answer: A

Rationale: Desmopressin promotes renal conservation of water by increasing the permeability of kidney collecting ducts to water, resulting in decreased urinary output. Therefore, the therapeutic response expected after administering desmopressin for diabetes insipidus is a reduction in urinary output.

4. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the client's teaching plan?

• A. Avoid taking folic acid supplements.
• B. Report any signs of infection immediately.
• C. Take the medication with a full meal.
• D. Limit fluid intake while on this medication.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the client's teaching plan when taking methotrexate is to report any signs of infection immediately. Methotrexate can suppress the immune system, making the client more susceptible to infections. It is important for the client to promptly report any signs of infection to receive timely medical intervention. Choice A is incorrect because folic acid supplements are often recommended to reduce side effects of methotrexate. Choice C is incorrect as methotrexate is usually taken on an empty stomach unless the client experiences gastrointestinal upset. Choice D is incorrect as there is no need to limit fluid intake while on methotrexate; in fact, maintaining adequate fluid intake is important to prevent complications such as kidney damage.

5. A client is receiving intravenous gentamicin (Garamycin). Which of the following findings should prompt the nurse to notify the healthcare provider immediately?

• A. Nausea
• B. Hearing loss
• C. Headache
• D. Diarrhea

Correct answer: B

Rationale: Gentamicin (Garamycin) is an aminoglycoside antibiotic known to cause ototoxicity, which can manifest as hearing loss. Hearing loss is a serious adverse effect that should be reported promptly to the healthcare provider to prevent further complications or adjust the treatment regimen. Nausea, headache, and diarrhea are common side effects of gentamicin but are not as severe or urgent as hearing loss in this context.

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