Nursing Elites

1. A client vomits 30 minutes after receiving a dose of hydromorphone on the first postoperative day. What initial intervention is best for the practical nurse (PN) to implement?

• A. Obtain a prescription for nasogastric intubation.
• B. Administer a prn dose of ondansetron.
• C. Reduce the next scheduled dose of hydromorphone.
• D. Assess the client's abdomen and bowel sounds.

Correct answer: B

Rationale: In this scenario, the client's vomiting is likely due to the hydromorphone administration, indicating a need for an antiemetic such as ondansetron to address the nausea. Nasogastric intubation (Choice A) is not necessary at this point as the client is vomiting, not experiencing an obstruction. While reducing the dose of hydromorphone (Choice C) may be considered later, the immediate focus should be managing the client's symptoms. Assessing the client's abdomen and bowel sounds (Choice D) can be important but is not the initial priority when addressing the vomiting post hydromorphone administration.

2. A client with hypertension is prescribed atenolol. The nurse should monitor the client for which potential side effect?

• A. Bradycardia
• B. Tachycardia
• C. Hypotension
• D. Hyperglycemia

Correct answer: A

Rationale: When a client is prescribed atenolol, a beta-blocker medication used to treat hypertension, the nurse should monitor for bradycardia as a potential side effect. Atenolol works by slowing the heart rate, and one common adverse effect is bradycardia, which is a slower than normal heart rate. Monitoring the client's heart rate is essential to detect and manage this potential side effect promptly. Choices B, C, and D are incorrect because atenolol typically does not cause tachycardia, hypotension, or hyperglycemia as primary side effects. Instead, bradycardia is a common concern due to the drug's mechanism of action in reducing heart rate.

3. A patient with irritable bowel syndrome starts a new prescription for dicyclomine, an anticholinergic medication. The client reports the onset of sensitivity to light and a dry mouth. How should the nurse respond?

• A. Determine if the medication is being taken correctly
• B. Provide instructions on managing these side effects
• C. Schedule an appointment for evaluation by the healthcare provider
• D. Advise stopping the medication until the unpleasant side effects wear off

Correct answer: B

Rationale: The correct response is to provide instructions on managing these side effects. Sensitivity to light and dry mouth are common side effects of anticholinergic medications like dicyclomine. It is essential for the nurse to educate the patient on strategies to cope with these side effects, such as staying hydrated to address dry mouth and wearing sunglasses to reduce sensitivity to light. Option A is not the priority as the side effects are expected with this medication and do not necessarily indicate incorrect use. Option C is not immediately necessary as the side effects are common and can be managed without a healthcare provider evaluation. Option D is not recommended unless advised by the healthcare provider as abruptly stopping the medication can lead to worsening symptoms or withdrawal effects.

4. A client who is newly diagnosed with erosive esophagitis secondary to GERD experiences symptoms after taking lansoprazole PO for one full week. Which actions should the nurse take?

• A. Confirm that the client is taking the medication correctly
• B. Auscultate the client's bowel sounds and assess the apical pulse
• C. Advise the client that healing typically takes several weeks
• D. Notify the healthcare provider to consider a higher dose

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to advise the client that healing from erosive esophagitis typically takes several weeks. Providing this information helps manage the client's expectations and anxiety about treatment effectiveness. It is not necessary to confirm medication timing, assess bowel sounds, or measure the apical pulse at this point. Since symptoms persist after one week of lansoprazole, it may not be appropriate to immediately escalate to a higher dose without further assessment or guidance from the healthcare provider. Auscultating bowel sounds and assessing the apical pulse are not relevant to the client's symptoms related to erosive esophagitis and GERD.

5. A client with a diagnosis of generalized anxiety disorder is prescribed buspirone. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: The correct potential side effect of buspirone is drowsiness. It is important for clients to be informed about this side effect, as it can affect their ability to perform tasks that require full alertness, such as driving. Clients should be advised to avoid activities that require mental alertness until they know how the medication affects them. Dry mouth is a common side effect of some other medications used for anxiety, such as benzodiazepines. Nausea and headache are not typically associated with buspirone use.

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