Nursing Elites

1. A healthcare provider is preparing to administer a transfusion of a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?

• A. Ensure that the client has a patent IV line before obtaining the blood product from the refrigerator.
• B. Obtain help from another healthcare provider to confirm the correct client and blood product.
• C. Take a complete set of vital signs before beginning the transfusion and periodically during the transfusion.
• D. Stay with the client for the first 15 to 30 minutes of the transfusion.

Correct answer: B

Rationale: The correct answer is to obtain help from another healthcare provider to confirm the correct client and blood product. This action is crucial in preventing an acute hemolytic reaction, which is caused by ABO or Rh incompatibility. Verifying the correct client and blood product before the transfusion ensures that there are no errors in identification, reducing the risk of a potentially life-threatening reaction. Choices A, C, and D are important aspects of transfusion safety but are not directly related to preventing acute hemolytic reactions. Ensuring a patent IV line, monitoring vital signs, and staying with the client are all essential during transfusion but do not specifically address the risk of ABO or Rh incompatibility reactions.

2. A client with increased intracranial pressure is receiving Mannitol. Which finding should the nurse report to the provider?

• A. Blood glucose 150 mg/dL
• B. Urine output 40 mL/hr
• C. Dyspnea
• D. Bilateral equal pupil size

Correct answer: C

Rationale: Dyspnea is a concerning finding in a client receiving Mannitol as it can be a manifestation of heart failure, an adverse effect of the medication. It suggests potential fluid overload or exacerbation of heart conditions, both of which require immediate attention. Reporting dyspnea promptly allows for timely evaluation and management. Blood glucose levels and urine output are important parameters to monitor but are not directly related to the administration of Mannitol for increased intracranial pressure. Bilateral equal pupil size is a normal and expected finding.

3. A client with Diabetes is experiencing Nausea due to Gastroparesis. The healthcare provider should anticipate a prescription for which of the following medications?

• A. Lubiprostone
• B. Metoclopramide
• C. Bisacodyl
• D. Loperamide

Correct answer: B

Rationale: Metoclopramide, a dopamine antagonist, is indicated for treating nausea and increasing gastric motility. In the context of diabetic gastroparesis, it can alleviate bloating and nausea by enhancing gastric emptying. Lubiprostone (Choice A) is a chloride channel activator used for chronic idiopathic constipation and irritable bowel syndrome with constipation. Bisacodyl (Choice C) is a stimulant laxative primarily used for constipation. Loperamide (Choice D) is an anti-diarrheal agent and would not be appropriate for treating nausea and gastroparesis.

4. A nurse is providing discharge instructions to a client who has a new prescription for a Fentanyl transdermal patch. Which of the following instructions should the nurse include?

• A. Apply the patch to a hairy area.
• B. Change the patch every 24 hours.
• C. Avoid exposure to heat sources.
• D. Cut the patch to adjust the dosage.

Correct answer: C

Rationale: The correct instruction that the nurse should include when providing discharge instructions for a client with a Fentanyl transdermal patch is to avoid exposure to heat sources. Heat can increase the absorption of the medication, leading to a risk of overdose. Choice A is incorrect because the patch should be applied to a clean, non-hairy area. Choice B is incorrect as the Fentanyl patch is usually changed every 72 hours, not every 24 hours. Choice D is incorrect as the patch should never be cut to adjust the dosage.

5. What is levothyroxine's pharmacologic classification?

• A. Thyroid Preparations
• B. Metabolic Inhibitors
• C. Analgesic
• D. Loop Diuretic

Correct answer: A

Rationale: Levothyroxine is classified as a thyroid preparation because it is a synthetic form of the thyroid hormone thyroxine. It is primarily used to treat hypothyroidism by supplementing or replacing the natural thyroid hormones in the body, helping to regulate metabolism and energy levels. Choice B, Metabolic Inhibitors, is incorrect because levothyroxine does not inhibit metabolism but rather helps regulate it. Choice C, Analgesic, is incorrect as levothyroxine is not used for pain relief but for thyroid hormone replacement therapy. Choice D, Loop Diuretic, is also incorrect as loop diuretics are medications that act on the kidneys to increase urine production and are not related to thyroid hormone replacement therapy.

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