Nursing Elites

1. A client has a new prescription for Trimethoprim-sulfamethoxazole. Which of the following information should the nurse include?

• A. Take the medication on an empty stomach.
• B. Maintain a fluid restriction while taking it.
• C. Take it with food.
• D. Stop taking it when manifestations subside.

Correct answer: C

Rationale: The correct answer is C: 'Take it with food.' Trimethoprim-sulfamethoxazole can cause gastrointestinal upset, and taking it with food helps reduce the risk of stomach irritation. It should not be taken on an empty stomach. Maintaining good hydration is important to prevent kidney-related side effects, so maintaining a fluid restriction, as in choice B, is not appropriate. Additionally, stopping the medication when manifestations subside, as in choice D, is incorrect as antibiotics should be taken for the full prescribed course to ensure eradication of the infection and to prevent antibiotic resistance.

2. When reviewing a client's health record, a healthcare professional notes that the client is experiencing episodes of hypokalemia. Which of the following medications should be identified as a cause of the client's hypokalemia?

• A. Captopril
• B. Lisinopril
• C. Furosemide
• D. Spironolactone

Correct answer: C

Rationale: Furosemide, a loop diuretic, can lead to hypokalemia by increasing the excretion of potassium in the urine. This potassium loss can result in lower-than-normal levels of potassium in the body, leading to hypokalemia.

3. A client with a history of migraine headaches is starting prophylaxis therapy with Propranolol. Which of the following findings in the client history should be reported to the provider by the nurse?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with a first-degree heart block due to its negative chronotropic properties that can further slow the heart rate. This can worsen conduction through the atrioventricular node, potentially leading to heart block progression. Therefore, the nurse should report the finding of a first-degree heart block to the provider before initiating Propranolol therapy. Choices A, B, and C are not contraindications for Propranolol therapy. A prior myocardial infarction, taking warfarin for atrial fibrillation, or using an SSRI for depression do not directly impact the initiation of Propranolol therapy in a client with a history of migraine headaches.

4. A client has a prescription for furosemide. Which of the following instructions should the nurse include?

• A. Take furosemide in the morning.
• B. Eat a diet high in potassium.
• C. Avoid foods that are high in magnesium.
• D. Limit your fluid intake to 1 liter per day.

Correct answer: B

Rationale: The correct answer is to 'Eat a diet high in potassium.' Furosemide is a loop diuretic that can cause hypokalemia (low potassium levels). Instructing the client to eat a diet high in potassium can help counteract the potassium-wasting effect of furosemide and prevent hypokalemia. Choice A is incorrect because furosemide can be taken at different times of the day based on individual needs. Choice C is incorrect as furosemide does not directly interact with magnesium levels. Choice D is incorrect because while fluid intake may need to be monitored, a specific limit of 1 liter per day is not a general instruction for all clients taking furosemide.

5. A healthcare professional is preparing to administer heparin 15,000 units subcutaneously every 12 hours. The available heparin injection is 20,000 units/mL. How many milliliters should the healthcare professional administer per dose?

• A. 0.8 mL
• B. 0.75 mL
• C. 0.5 mL
• D. 1 mL

Correct answer: A

Rationale: To calculate the volume to administer, use the formula: Desired dose / Concentration = Volume to administer. In this case, (15,000 units / 20,000 units/mL) = 0.75 mL. Since the volume needs to be rounded up to the nearest tenth, the correct answer is 0.8 mL. Choice B (0.75 mL) is incorrect because it does not account for rounding up the volume. Choices C (0.5 mL) and D (1 mL) are incorrect as they do not reflect the precise calculation based on the given concentration and desired dose.

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