Nursing Elites

1. A client is undergoing preparation for extensive colorectal surgery. Which of the following oral antibiotics should be administered to suppress normal flora in the GI tract?

• A. Kanamycin
• B. Gentamicin
• C. Neomycin
• D. Tobramycin

Correct answer: C

Rationale: The correct answer is C: Neomycin. Neomycin, an aminoglycoside antibiotic, is administered orally before GI surgery to eliminate the normal flora in the large intestine. This helps reduce the risk of postoperative infections by decreasing the bacterial load in the gut. Choices A, B, and D (Kanamycin, Gentamicin, Tobramycin) are not typically used to suppress normal flora in the GI tract before colorectal surgery.

2. A healthcare provider is providing discharge instructions to a client who is prescribed Enalapril. Which of the following adverse effects should the healthcare provider instruct the client to monitor?

• A. Dry cough
• B. Weight gain
• C. Diarrhea
• D. Nausea

Correct answer: A

Rationale: The correct answer is A: Dry cough. A persistent dry cough is a common adverse effect of Enalapril, an ACE inhibitor. Enalapril can cause a non-productive cough due to its effect on bradykinin levels. The client should be advised to report this symptom to their healthcare provider to consider alternative treatments. Choices B, C, and D are incorrect because weight gain, diarrhea, and nausea are not typically associated with Enalapril use.

3. While providing an Angiotensin-converting enzyme (ACE) inhibitor, the patient asks what the action of the drug is. As a healthcare provider, you explain that the action of an ACE inhibitor is:

• A. To lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II
• B. To inhibit reabsorption of sodium back into the body, ultimately increasing urine output and lowering blood pressure
• C. To decrease heart rate and blood pressure by competing with Beta1 and Beta2 receptors in the heart and lungs
• D. To lower blood glucose by stimulating the release of insulin

Correct answer: A

Rationale: ACE inhibitors lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II. Angiotensin II is a potent vasoconstrictor, and by inhibiting its formation, ACE inhibitors help dilate blood vessels, reduce blood pressure, and decrease the workload on the heart. Choice B is incorrect as it describes the mechanism of action of diuretics, not ACE inhibitors. Choice C is incorrect as it refers to the action of beta-blockers, not ACE inhibitors. Choice D is incorrect as it describes the mechanism of action of antidiabetic medications, not ACE inhibitors.

4. A client is taking Paroxetine to treat PTSD and reports teeth grinding at night. Which interventions should the nurse implement to manage Bruxism? (Select all that apply.)

• A. Concurrent administration of buspirone.
• B. Administration of a different SSRI.
• C. Use of a mouth guard.
• D. Changing to a different class of antidepressant medication.

Correct answer: A

Rationale: The correct interventions to manage Bruxism associated with Paroxetine use include A: Concurrent administration of buspirone. Buspirone can help alleviate the side effect of Bruxism. Additionally, C: Use of a mouth guard is recommended to prevent oral damage from teeth grinding. B: Administration of a different SSRI is not necessary since the issue is specific to Paroxetine. D: Changing to a different class of antidepressant medication may be considered in severe cases, but the initial step should be to add buspirone to address the Bruxism caused by Paroxetine.

5. A client with congestive heart failure taking digoxin refused breakfast and is complaining of nausea and weakness. Which action should the nurse take first?

• A. Check the client's vital signs.
• B. Request a consult with a dietitian.
• C. Suggest that the client rests before eating the meal.
• D. Request an order for an antiemetic.

Correct answer: A

Rationale: The nurse should check the client's vital signs first because nausea and weakness can be signs of digoxin toxicity. Vital signs can provide immediate information on the client's condition and help guide further interventions. Monitoring vital signs will allow the nurse to assess for bradycardia, a common sign of digoxin toxicity. Requesting a dietitian consult (choice B) may be necessary but addressing the immediate concern of toxicity is the priority. Suggesting rest before eating (choice C) may not address the underlying issue of digoxin toxicity. Requesting an antiemetic (choice D) can be considered later but is not the initial action needed in this situation.

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