Nursing Elites

1. A client with chronic renal failure is prescribed epoetin alfa (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Decreased blood pressure.
• C. Improved hemoglobin levels.
• D. Stable potassium levels.

Correct answer: C

Rationale: Epoetin alfa is a medication that stimulates red blood cell production. Therefore, in a client with chronic renal failure, an effective outcome of epoetin alfa therapy would be an improvement in hemoglobin levels. This indicates that the medication is working as intended by addressing anemia, a common complication of chronic renal failure. Increased urine output (choice A) is not directly related to the action of epoetin alfa. Decreased blood pressure (choice B) is not a primary expected outcome of epoetin alfa therapy. Stable potassium levels (choice D) are important but not a direct indicator of the effectiveness of epoetin alfa in this context.

2. A client with hypothyroidism is prescribed levothyroxine (Synthroid). Which instruction should the nurse provide?

• A. Take the medication with a meal.
• B. Take the medication at bedtime.
• C. Take the medication on an empty stomach.
• D. Take the medication with an antacid.

Correct answer: C

Rationale: The correct instruction for a client prescribed levothyroxine (Synthroid) is to take the medication on an empty stomach. This ensures optimal absorption of levothyroxine. Taking it with a meal can interfere with absorption due to food interactions. Taking it at bedtime may lead to inconsistent absorption as it should be taken at the same time every day in the morning. Taking it with an antacid can reduce the absorption of levothyroxine, making it less effective.

3. While assessing a 70-year-old female client with Alzheimer's disease, the nurse notes deep inflamed cracks at the corners of her mouth. What intervention should the nurse include in this client's plan of care?

• A. Apply a moisturizing cream to the affected areas.
• B. Encourage the client to consume foods rich in vitamin B.
• C. Notify the healthcare provider for further evaluation.
• D. Ensure that the client gets adequate B vitamins in foods or supplements.

Correct answer: D

Rationale: Cracks at the corners of the mouth, known as angular cheilitis, can be a sign of vitamin B deficiency, specifically B2 (riboflavin) or B3 (niacin). The nurse should ensure that the client receives adequate B vitamins through foods rich in these nutrients or supplements to address the deficiency, which can help improve the condition of the client's mouth.

4. A highly successful individual presents to the community mental health center complaining of sleeplessness and anxiety over their financial status. What action should the nurse take to assist this client in diminishing their anxiety?

• A. Encourage them to initiate daily rituals.
• B. Reinforce the reality of their financial situation.
• C. Direct them to drink a glass of red wine at bedtime.
• D. Teach them to limit sugar and caffeine intake.

Correct answer: D

Rationale: Teaching the individual to limit sugar and caffeine intake is an appropriate intervention to reduce anxiety and improve sleep quality. Sugar and caffeine can exacerbate anxiety symptoms and disrupt sleep patterns. By reducing their intake, the individual may experience a decrease in anxiety levels and better sleep. Encouraging daily rituals, reinforcing financial realities, or suggesting alcohol consumption before bed are not evidence-based strategies for managing anxiety and sleeplessness.

5. A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?

• A. Peptic stricture
• B. Esophageal cancer
• C. Achalasia
• D. Esophageal spasm

Correct answer: B

Rationale: The presentation of difficulty swallowing, weight loss, and worsening symptoms despite long-term use of proton-pump inhibitors raises suspicion for esophageal cancer, especially in a patient with a history of chronic heartburn. Esophageal cancer should be considered in this scenario due to the concerning symptoms and lack of improvement despite appropriate medical management.

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