Nursing Elites

1. A client with type 2 diabetes is prescribed metformin. What instruction should the practical nurse (PN) include in the client's teaching plan?

• A. Take the medication with meals to decrease gastrointestinal upset.
• B. Take the medication with a full glass of water.
• C. Avoid alcohol while taking the medication.
• D. Take the medication with meals to increase absorption.

Correct answer: B

Rationale: The correct instruction for a client prescribed metformin is to take the medication with a full glass of water. This helps ensure proper ingestion and absorption of the medication. While taking metformin with meals can help reduce gastrointestinal side effects, the primary focus should be on adequate hydration and absorption by taking it with water. Avoiding alcohol while taking metformin is also important as alcohol can increase the risk of lactic acidosis when combined with metformin. Taking the medication with meals to increase absorption is incorrect as metformin should be taken with food to reduce gastrointestinal upset, not to increase absorption.

2. A client with a diagnosis of schizophrenia is prescribed risperidone. The nurse should monitor the client for which potential side effect?

• A. Weight gain
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: When a client is prescribed risperidone, it is essential to monitor for potential side effects. Weight gain is a common side effect of risperidone, so the nurse should closely monitor the client's weight throughout the treatment. This monitoring helps in early detection of weight changes and allows for timely interventions to prevent further complications.

3. A client with pulmonary tuberculosis has been taking rifampin for 3 weeks. The client reports orange urine. What should be the nurse's next action?

• A. Notify the client's health care provider.
• B. Inform the client that this is not harmful.
• C. Assess the client for other signs of nephrotoxicity.
• D. Monitor the client's most recent creatinine level.

Correct answer: B

Rationale: The correct action for the nurse to take when a client reports orange urine after taking rifampin is to inform the client that this change is not harmful. Rifampin is known to cause orange discoloration of urine, which is a harmless side effect. There is no need to notify the health care provider as this is an expected outcome. Monitoring creatinine levels or assessing for nephrotoxicity is unnecessary in this situation, as rifampin does not typically cause kidney damage.

4. A client with a history of deep vein thrombosis is prescribed apixaban. The nurse should monitor for which potential adverse effect?

• A. Increased risk of bleeding
• B. Decreased risk of bleeding
• C. Increased risk of infection
• D. Decreased risk of infection

Correct answer: A

Rationale: The correct answer is A: Increased risk of bleeding. Apixaban is an anticoagulant medication that works by preventing blood clots. While this is beneficial for individuals with a history of deep vein thrombosis, it also increases the risk of bleeding. Therefore, the nurse should monitor the client for signs of bleeding, such as easy bruising, prolonged bleeding from cuts, or blood in the urine or stool. Monitoring for bleeding is crucial to ensure the client's safety and to take appropriate actions if necessary. Choices B, C, and D are incorrect because apixaban does not decrease the risk of bleeding, increase the risk of infection, or decrease the risk of infection. The primary concern when administering apixaban is monitoring for potential bleeding complications.

5. Twenty-four hours after starting to take oral penicillin for strep throat, a client calls the nurse to report the onset of a rash on the chest. What action should the nurse implement?

• A. Instruct the client to discontinue the penicillin immediately
• B. Instruct the client regarding the use of topical analgesic cream PRN
• C. Question the client about any other related symptoms
• D. Reinforce the need to take all doses of the penicillin

Correct answer: A

Rationale: In this scenario, the client has developed a rash after starting oral penicillin, which can indicate an allergic reaction. It is crucial for the nurse to instruct the client to discontinue the penicillin immediately. Continuing the medication can potentially lead to severe allergic reactions. Instructing about topical analgesic cream or questioning about other related symptoms may delay appropriate action in case of a severe allergic reaction. Reinforcing the need to complete all doses is not appropriate when an allergic reaction is suspected, as safety takes precedence over completing the antibiotic course.

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