Nursing Elites

1. A client with cirrhosis is about to receive a dose of lactulose. The client questions the need for the medication, stating they are not constipated. The nurse should explain that lactulose is used in cirrhosis to reduce levels of which component in the bloodstream?

• A. Glucose
• B. Ammonia
• C. Potassium
• D. Bicarbonate

Correct answer: B

Rationale: Lactulose is administered to clients with cirrhosis to lower blood ammonia levels, thus aiding in the prevention of hepatic encephalopathy. Elevated ammonia levels in cirrhosis can lead to cognitive impairment and hepatic encephalopathy. Therefore, the correct answer is B (Ammonia). Glucose (Choice A) is not the component targeted by lactulose in cirrhosis. Potassium (Choice C) and Bicarbonate (Choice D) are not directly affected by lactulose administration in cirrhosis.

2. A healthcare provider is caring for a 4-year-old child who is resistant to taking medication. Which of the following strategies should the healthcare provider use to elicit the child's cooperation?

• A. Offer the child a choice of taking the medication with juice or water
• B. Tell the child it is candy
• C. Hide the medication in a large dish of ice cream
• D. Tell the child they will have a shot instead

Correct answer: A

Rationale: Offering children choices empowers them and can help in gaining cooperation, especially when it comes to taking medications. By providing options like taking the medication with juice or water, the child feels a sense of control and may be more willing to cooperate. This approach respects the child's autonomy and can make the experience more positive for both the child and the healthcare provider. Choices B, C, and D are not ideal strategies as they involve deception or coercion, which can lead to distrust and make the child more resistant to taking medication in the future.

3. A client has a new prescription for Zolpidem. Which of the following instructions should the nurse include?

• A. Notify the provider if you plan to become pregnant.
• B. Take the medication 1 hr before you plan to go to sleep.
• C. Allow at least 6 hr for sleep when taking Zolpidem.
• D. To increase the effectiveness of Zolpidem, take it with a bedtime snack.

Correct answer: A

Rationale: Zolpidem is classified under Pregnancy Risk Category C. It is essential for the client to inform the provider if she plans to become pregnant as Zolpidem use during pregnancy may pose risks to the fetus. This precaution allows for appropriate assessment and possible adjustments to the treatment plan to ensure the safety of both the client and the developing baby. Choice B is incorrect because Zolpidem is usually taken immediately before bedtime, not 1 hour before. Choice C is incorrect as Zolpidem is known for its quick onset of action, and the client does not need to allocate a specific amount of time for sleep. Choice D is incorrect as taking Zolpidem with food, especially a bedtime snack, may delay its onset of action.

4. A client is receiving heparin therapy. Which laboratory value should be monitored by the nurse to evaluate the effectiveness of the therapy?

• A. PT
• B. aPTT
• C. INR
• D. Platelet count

Correct answer: B

Rationale: The activated partial thromboplastin time (aPTT) is specifically used to monitor the effectiveness of heparin therapy. It should be maintained at 1.5 to 2 times the normal level. Monitoring aPTT helps ensure that the therapeutic range of heparin is achieved to prevent clot formation while minimizing the risk of bleeding complications. Choice A (PT) is incorrect as it is used to monitor warfarin therapy, not heparin. Choice C (INR) is also incorrect as it is primarily used to monitor warfarin therapy. Choice D (Platelet count) is not directly related to monitoring the effectiveness of heparin therapy.

5. A client is prescribed Ciprofloxacin and seeks guidance from a nurse. Which instruction should the nurse provide?

• A. Take this medication with meals.
• B. Avoid taking this medication with dairy products.
• C. Take this medication at bedtime.
• D. Increase your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct answer is B: 'Avoid taking this medication with dairy products.' Ciprofloxacin should not be taken with dairy products due to the interference of calcium with medication absorption. Taking Ciprofloxacin 1 hour before or 2 hours after consuming dairy products ensures optimal effectiveness. Choice A is incorrect because Ciprofloxacin is usually taken on an empty stomach or with a light meal, not necessarily with heavy meals. Choice C is incorrect as there is no specific instruction to take Ciprofloxacin at bedtime. Choice D is incorrect because there is no need to increase potassium-rich foods intake specifically related to Ciprofloxacin use.

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