Nursing Elites

1. A client with asthma is prescribed montelukast. The nurse should instruct the client that this medication is used for which purpose?

• A. Immediate relief of acute asthma attacks
• B. Long-term control of asthma symptoms
• C. Treatment of exercise-induced bronchospasm
• D. Immediate relief of allergic rhinitis symptoms

Correct answer: B

Rationale: Montelukast is a leukotriene receptor antagonist used for the long-term control of asthma symptoms by reducing inflammation in the airways. It is not typically used for immediate relief during acute asthma attacks, where short-acting bronchodilators are more appropriate. Montelukast does not specifically target exercise-induced bronchospasm or allergic rhinitis symptoms. Therefore, the correct answer is B. Choice A is incorrect because montelukast is not for immediate relief of acute asthma attacks. Choice C is incorrect as montelukast is not primarily used to treat exercise-induced bronchospasm. Choice D is incorrect because montelukast is not indicated for immediate relief of allergic rhinitis symptoms.

2. A client who takes metformin for diabetes mellitus type 2 is nothing by mouth (NPO) for surgery. What pre-op prescription should the practical nurse (PN) anticipate for this client's glucose management?

• A. NPO except for metformin and regular snacks
• B. NPO except for oral antidiabetic agent
• C. Novolin-N insulin subcutaneously twice daily
• D. Regular insulin subcutaneously per sliding scale

Correct answer: D

Rationale: When a client taking metformin for diabetes mellitus type 2 is NPO for surgery, it is crucial to manage their glucose levels effectively. The best approach in this situation is to prescribe regular insulin subcutaneously according to a sliding scale based on the client's blood glucose levels. This method allows for precise adjustment of insulin doses to maintain blood glucose within the target range while the client is unable to take oral medications. Choices A and B are incorrect because metformin is typically held when a client is NPO, and oral antidiabetic agents may not provide sufficient glucose control. Choice C is incorrect as Novolin-N insulin given twice daily may not offer the flexibility needed for glucose management in a surgical setting where the client's intake is restricted.

3. A client with asthma is prescribed fluticasone. The nurse should instruct the client to use this medication at which time?

• A. During an asthma attack
• B. Twice a day
• C. Once a day
• D. At night before bed

Correct answer: C

Rationale: Fluticasone is a maintenance medication for asthma aimed at controlling symptoms. It should be taken once a day on a regular basis to provide ongoing relief and prevent asthma symptoms, rather than being used to treat acute asthma attacks. Therefore, the correct answer is to use it once a day. Choices A, B, and D are incorrect because using fluticasone during an asthma attack, twice a day, or only at night before bed does not align with the medication's purpose of being a daily maintenance therapy.

4. A client arrives at the emergency department experiencing diabetic ketoacidosis (DKA). The healthcare provider prescribes an insulin intravenous drip. Which type of insulin should the nurse locate for the registered nurse to mix into the intravenous fluids?

• A. Isophane
• B. Glargine
• C. Regular
• D. Detemir

Correct answer: C

Rationale: The correct insulin type for the nurse to mix into the intravenous fluids is regular insulin. In the scenario of diabetic ketoacidosis (DKA), rapid reduction of blood glucose levels is crucial. Regular insulin has a fast onset of action, making it suitable for intravenous administration to address the high blood sugar levels seen in DKA. Isophane, Glargine, and Detemir are not appropriate choices for intravenous administration in this emergency situation as they are intermediate-acting or long-acting insulins which do not provide the rapid response needed in DKA.

5. A home health care nurse observes that a client with Parkinson's syndrome is experiencing increased tremors and difficulty in movement. What should the nurse do in response to this finding?

• A. Report the observed finding to the healthcare provider right away
• B. Arrange a medical evaluation so the medication dose can be adjusted
• C. Schedule a return home visit in 2 weeks to monitor
• D. Explain that this is an expected progression of Parkinson's

Correct answer: B

Rationale: In a client with Parkinson's syndrome experiencing increased tremors and movement difficulty, arranging a medical evaluation is crucial to adjust the medication dose. This proactive approach helps in managing the symptoms effectively. Reporting the finding to the healthcare provider may delay necessary adjustments in treatment. Scheduling a return home visit in 2 weeks may not address the immediate need for medication adjustment. Explaining that the progression is expected without taking action does not address the client's worsening symptoms.

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