Nursing Elites

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

• A. Take this medication in the morning.
• B. Consume potassium-rich foods.
• C. Take this medication with food.
• D. Monitor for signs of dehydration.

Correct answer: D

Rationale: The correct answer is to monitor for signs of dehydration. Hydrochlorothiazide is a diuretic that can lead to fluid loss and dehydration. The client should be educated to watch for symptoms like dry mouth, increased thirst, weakness, dizziness, and decreased urine output. Prompt recognition of dehydration signs is crucial for timely intervention and prevention of complications. Choices A, B, and C are incorrect. Taking Hydrochlorothiazide in the morning is not a specific instruction for this medication. While potassium-rich foods can be important when taking certain medications, it is not the priority instruction for Hydrochlorothiazide. Taking this medication with food may help reduce stomach upset but is not the most critical instruction for a diuretic like Hydrochlorothiazide.

2. A client with heart failure is being instructed on laxative use. Which of the following laxatives should the client avoid?

• A. Sodium phosphate
• B. Psyllium
• C. Bisacodyl
• D. Polyethylene glycol

Correct answer: A

Rationale: The correct answer is A: Sodium phosphate. Clients with heart failure often follow a sodium-restricted diet. Sodium phosphate laxatives can lead to sodium absorption, causing fluid retention, which is contraindicated in heart failure. It is crucial to avoid sodium phosphate laxatives in these clients to prevent exacerbation of fluid overload and heart failure symptoms. Psyllium (choice B), Bisacodyl (choice C), and Polyethylene glycol (choice D) are not contraindicated in clients with heart failure and can be used safely for bowel management.

3. How is lithium typically administered?

• A. Intravenously
• B. Intramuscularly
• C. Orally
• D. Sublingually

Correct answer: C

Rationale: Lithium is typically administered orally to ensure proper absorption and distribution in the body. By taking lithium orally, it allows the medication to be absorbed through the gastrointestinal tract and distributed effectively. Intravenous and intramuscular routes are not commonly used for lithium administration as they can lead to rapid, unpredictable absorption and increase the risk of toxicity. Sublingual administration is also not the typical route for lithium, as it is usually taken orally for consistent and controlled absorption.

4. A healthcare professional 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 professional 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: Obtaining help from another healthcare professional to confirm the correct client and blood product is crucial in preventing an acute hemolytic reaction during a blood transfusion. This reaction occurs due to ABO or Rh incompatibility. Verifying the correct client and blood product reduces the risk of administering the wrong blood type, which could lead to a life-threatening reaction. Checking for patency of the IV line (Choice A) is important but does not directly prevent an acute hemolytic reaction. Monitoring vital signs (Choice C) is essential for detecting transfusion reactions but does not prevent them. Staying with the client (Choice D) is important for early recognition of adverse reactions but does not address the root cause of preventing an acute hemolytic reaction.

5. A client in a long-term care facility has Hypothyroidism and a new prescription for Levothyroxine. Which of the following dosage schedules should the nurse expect for this client?

• A. The client will start at a high dose, and the dose will be tapered as needed.
• B. The client will remain on the initial dosage during the course of treatment.
• C. The client's dosage will be adjusted daily based on blood levels.
• D. The client will start on a low dose, which will be gradually increased.

Correct answer: D

Rationale: The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This cautious approach is crucial, especially in older adult clients, to prevent toxicity and ensure optimal therapeutic outcomes for managing hypothyroidism. Choice A is incorrect because starting at a high dose and tapering as needed is not the standard approach for levothyroxine. Choice B is incorrect because the initial dosage is typically adjusted to reach the optimal therapeutic dose. Choice C is incorrect as adjusting the dosage daily based on blood levels is not necessary for levothyroxine, as it has a long half-life and requires time to reach a steady state.

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