Nursing Elites

1. A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?

• A. Advise the client to use the pump sparingly to prevent addiction
• B. Encourage the client to use the PCA before dressing changes
• C. Encourage the client's family to administer PCA while the client is sleeping
• D. Increase the client's 4-hour limit as needed

Correct answer: B

Rationale: The correct answer is B because encouraging the client to use the PCA before dressing changes helps in managing pain proactively. Choice A is incorrect as PCA is a safe method of pain control when used appropriately, and the nurse should not suggest using it sparingly. Choice C is incorrect as only the client should operate the PCA to ensure they are in control of their pain management. Choice D is incorrect as changing the PCA limit without proper assessment and orders from the healthcare provider can lead to adverse effects.

2. A client is receiving magnesium sulfate for the management of preeclampsia. Which of the following client assessments should the nurse monitor to prevent complications of therapy?

• A. Bowel sounds
• B. Deep tendon reflexes
• C. Oxygen saturation
• D. Fluid balance

Correct answer: B

Rationale: The correct answer is deep tendon reflexes. Monitoring deep tendon reflexes is crucial to assess for magnesium toxicity during therapy for preeclampsia. Magnesium sulfate can lead to neuromuscular blockade, reflected by decreased or absent deep tendon reflexes. Assessing bowel sounds (choice A) is important for gastrointestinal function but is not directly related to magnesium sulfate therapy. Oxygen saturation (choice C) is vital for respiratory status but is not specifically linked to magnesium sulfate administration. Fluid balance (choice D) is essential but does not directly correlate with monitoring for complications of magnesium sulfate therapy in the context of preeclampsia.

3. Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy?

• A. Hepatotoxicity
• B. Wernicke's aphasia
• C. Suicidal ideations
• D. Diarrhea

Correct answer: A

Rationale: The correct answer is A: Hepatotoxicity. Disulfiram is known to cause hepatotoxicity as a severe adverse effect. This occurs due to the inhibition of aldehyde dehydrogenase, leading to the accumulation of acetaldehyde when alcohol is consumed. Wernicke's aphasia (Choice B) is a language disorder unrelated to disulfiram therapy. Suicidal ideations (Choice C) may be associated with certain medications, but it is not a common adverse effect of disulfiram. Diarrhea (Choice D) is not a typical adverse effect of disulfiram.

4. A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not associated with this therapy?

• A. Tolerance
• B. Orthostatic hypotension
• C. Headache
• D. Productive cough

Correct answer: D

Rationale: The correct answer is D: Productive cough. Nitroglycerin therapy can lead to adverse effects such as tolerance, orthostatic hypotension, and headache. However, it is not known to cause a productive cough. Tolerance may develop over time, requiring dose adjustments. Orthostatic hypotension can occur due to vasodilation effects, leading to a sudden drop in blood pressure when changing positions. Headache is a common side effect due to vasodilation of cranial blood vessels. Productive cough is not a recognized adverse effect associated with transdermal nitroglycerin therapy.

5. A healthcare provider is preparing to administer heparin sodium to a client with deep vein thrombosis (DVT). Which of the following laboratory values should the provider monitor during therapy?

• A. INR
• B. Serum creatinine
• C. aPTT
• D. Bilirubin

Correct answer: C

Rationale: The correct answer is C: aPTT. The healthcare provider should monitor the activated partial thromboplastin time (aPTT) value during heparin therapy to assess the client's coagulation status. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure that the client is within the therapeutic range to prevent bleeding or clotting issues. INR (Choice A) is used to monitor warfarin therapy, not heparin. Serum creatinine (Choice B) is not directly related to monitoring heparin therapy. Bilirubin (Choice D) is related to liver function, not heparin therapy.

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