Nursing Elites

1. A client is learning how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

• A. Withdraws the NPH insulin first
• B. Withdraws the regular insulin first
• C. Injects air into the NPH insulin vial first
• D. Injects an amount of air equal to the desired dose of insulin into the vial

Correct answer: A

Rationale: When mixing regular insulin with another insulin preparation, it is crucial to withdraw the regular insulin first to prevent contamination. NPH insulin should be drawn after the regular insulin to maintain the integrity of each insulin type. Therefore, if the client withdraws the NPH insulin first, it indicates the need for further teaching. Choice B is correct as withdrawing regular insulin first is the appropriate step. Choice C is incorrect as air should be injected into the vial containing the regular insulin to maintain pressure. Choice D is incorrect as injecting air equal to the desired dose of insulin into the vial is a correct step in preparing the insulin for withdrawal.

2. A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question?

• A. Cyclobenzaprine (Flexeril)
• B. Alendronate (Fosamax)
• C. Allopurinol (Zyloprim)
• D. Prednisone

Correct answer: D

Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, reducing the body's ability to withstand stress. During surgery, the dosage may need to be adjusted due to its impact on the body's stress response. Choices A, B, and C are not typically contraindicated before surgery and do not have the same potential impact on the body's stress response.

3. The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?

• A. Constipation
• B. Abdominal pain
• C. An episode of diarrhea
• D. Hematest-positive nasogastric tube drainage

Correct answer: C

Rationale: Loperamide hydrochloride (Imodium) is an antidiarrheal medication commonly used to manage episodes of diarrhea. It works by slowing down gut movement and reducing the frequency of bowel movements. Loperamide is not indicated for constipation, abdominal pain, or hematest-positive nasogastric tube drainage. It is specifically useful in acute and chronic diarrhea, such as in cases of inflammatory bowel disease, to help control symptoms and decrease fluid loss.

4. A client is receiving vancomycin (Vancocin). Which of the following is the most important action for the nurse to take?

• A. Monitor the client for signs of nephrotoxicity.
• B. Monitor the client for signs of ototoxicity.
• C. Ensure adequate hydration.
• D. Administer the medication with food.

Correct answer: A

Rationale: The most important action for the nurse to take when a client is receiving vancomycin is to monitor for signs of nephrotoxicity. Vancomycin can cause kidney damage, so monitoring kidney function and signs of nephrotoxicity are crucial to prevent harm. While monitoring for ototoxicity and ensuring adequate hydration are important nursing actions, they are not as critical as preventing nephrotoxicity when administering vancomycin.

5. Before initiating a client with tuberculosis on anti-tuberculosis therapy with isoniazid (INH), a nurse ensures that which of the following baseline study has been completed?

• A. Electrolyte levels
• B. Coagulation times
• C. Liver enzyme levels
• D. Serum creatinine level

Correct answer: C

Rationale: Before starting INH therapy for tuberculosis, it is essential to assess liver enzyme levels as INH can cause hepatotoxicity. Monitoring liver enzyme levels before and during the initial 3 months of therapy is crucial to detect any liver damage early and prevent further complications. Choice A, electrolyte levels, are not directly impacted by INH therapy. Choice B, coagulation times, are not routinely monitored before starting INH therapy. Choice D, serum creatinine level, is not specifically required as a baseline study before initiating INH therapy for tuberculosis.

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