Nursing Elites

1. A client is receiving vancomycin (Vancocin). Which of the following is the most important action for the nurse to take?

• A. Monitor the client for signs of nephrotoxicity.
• B. Monitor the client for signs of ototoxicity.
• C. Ensure adequate hydration.
• D. Administer the medication with food.

Correct answer: A

Rationale: The most important action for the nurse to take when a client is receiving vancomycin is to monitor for signs of nephrotoxicity. Vancomycin can cause kidney damage, so monitoring kidney function and signs of nephrotoxicity are crucial to prevent harm. While monitoring for ototoxicity and ensuring adequate hydration are important nursing actions, they are not as critical as preventing nephrotoxicity when administering vancomycin.

2. A client is learning how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

• A. Withdraws the NPH insulin first
• B. Withdraws the regular insulin first
• C. Injects air into the NPH insulin vial first
• D. Injects an amount of air equal to the desired dose of insulin into the vial

Correct answer: A

Rationale: When mixing regular insulin with another insulin preparation, it is crucial to withdraw the regular insulin first to prevent contamination. NPH insulin should be drawn after the regular insulin to maintain the integrity of each insulin type. Therefore, if the client withdraws the NPH insulin first, it indicates the need for further teaching. Choice B is correct as withdrawing regular insulin first is the appropriate step. Choice C is incorrect as air should be injected into the vial containing the regular insulin to maintain pressure. Choice D is incorrect as injecting air equal to the desired dose of insulin into the vial is a correct step in preparing the insulin for withdrawal.

3. A healthcare provider is preparing to administer a prescribed dose of digoxin (Lanoxin) to a client. Before administering the medication, the healthcare provider should:

• A. Measure the client's blood pressure.
• B. Check the client's heart rate.
• C. Assess the client's respiratory rate.
• D. Check the client's oxygen saturation level.

Correct answer: B

Rationale: Before administering digoxin (Lanoxin), the healthcare provider should check the client's heart rate. Monitoring the heart rate is crucial because if it is below 60 beats per minute, the medication should be withheld, and the healthcare provider must be informed. While blood pressure, respiratory rate, and oxygen saturation are essential assessments, they are not the primary focus before administering digoxin.

4. A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?

• A. I will take my pills every day at the same time.
• B. I will be certain to avoid alcohol consumption.
• C. I have already called my family to pick up a Medic-Alert bracelet.
• D. I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated.

Correct answer: D

Rationale: Ecotrin is an aspirin-containing product and should be avoided. Clients should avoid alcohol consumption, take prescribed medication at the same time each day, and use a Medic-Alert bracelet for emergency information.

5. A client is receiving sulfisoxazole. Which of the following should be included in the list of instructions?

• A. Restrict fluid intake.
• B. Maintain a high fluid intake.
• C. If the urine turns dark brown, call the healthcare provider (HCP) immediately.
• D. Decrease the dosage when symptoms are improving to prevent an allergic response.

Correct answer: B

Rationale: When a client is taking sulfisoxazole, it is important to maintain a high fluid intake. Each dose of sulfisoxazole should be taken with a full glass of water, as the medication is more soluble in alkaline urine. Restricting fluid intake is not recommended as it can lead to inadequate hydration. Dark brown urine may be a side effect of some forms of sulfisoxazole but does not necessarily warrant immediate notification of the healthcare provider unless accompanied by other concerning symptoms. Decreasing the dosage when symptoms improve is not advised as it may lead to treatment failure or the development of resistance.

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