Nursing Elites

1. A client has a new prescription for clonidine to treat hypertension. Which of the following instructions should the nurse include?

• A. Discontinue the medication if a rash develops.
• B. Expect increased salivation during the first few weeks of therapy.
• C. Avoid driving until the client's reaction to the medication is known.
• D. Stop the medication if you experience a dry mouth.

Correct answer: C

Rationale: The correct instruction for a client starting clonidine therapy for hypertension is to avoid driving until their reaction to the medication is known. Clonidine can cause drowsiness, so it is important for the client to refrain from activities that require alertness until they are aware of how the medication affects them. Choice A is incorrect because a rash is not a common side effect of clonidine. Choice B is incorrect as increased salivation is not an expected side effect of clonidine. Choice D is also incorrect as dry mouth is a common side effect of clonidine, but it is not a reason to stop the medication unless severe or bothersome. Therefore, the priority instruction for the nurse to include is to advise the client to avoid driving until their reaction to the medication is known to ensure safety.

2. A healthcare professional is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion. Which of the following results indicates that the heparin infusion should be increased?

• A. aPTT of 90 seconds
• B. Platelet count of 150,000/mm³
• C. INR of 1.0
• D. Hgb of 15 g/dL

Correct answer: A

Rationale: An aPTT of 90 seconds is above the therapeutic range for heparin, which typically falls between 60-80 seconds. This indicates that the current heparin dose is too high, and the infusion rate should be decreased to avoid excessive anticoagulation and the risk of bleeding. Monitoring aPTT is crucial in adjusting heparin therapy to maintain it within the therapeutic range.

3. When should Montelukast be taken?

• A. At least two hours before exercise
• B. Daily in the evening
• C. Two hours before exercise or daily in the evening
• D. None of the above

Correct answer: B

Rationale: Montelukast should be taken daily in the evening to effectively manage asthma symptoms. Taking it at the same time each day helps maintain a consistent level of the medication in the body, providing optimal control over asthma symptoms and inflammation. Choice A is incorrect because Montelukast should not be taken specifically before exercise, but rather daily. Choice C is incorrect because although taking Montelukast two hours before exercise is not necessary, taking it daily in the evening is essential for its effectiveness. Choice D is incorrect as Montelukast should be taken daily to manage asthma.

4. A healthcare professional is administering a Dopamine infusion at a low dose to a client with severe heart failure. Which of the following findings is an expected effect of this medication?

• A. Lowered heart rate
• B. Increased myocardial contractility
• C. Decreased conduction through the AV node
• D. Vasoconstriction of renal blood vessels

Correct answer: B

Rationale: Dopamine, when administered at a low dose, is expected to increase myocardial contractility by stimulating beta1 receptors. This positive inotropic effect leads to an increase in cardiac output. Therefore, the correct answer is increased myocardial contractility, as it is a desired effect of administering dopamine to a client with severe heart failure.

5. While providing an Angiotensin-converting enzyme (ACE) inhibitor, the patient asks what the action of the drug is. As a healthcare provider, you explain that the action of an ACE inhibitor is:

• A. To lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II
• B. To inhibit reabsorption of sodium back into the body, ultimately increasing urine output and lowering blood pressure
• C. To decrease heart rate and blood pressure by competing with Beta1 and Beta2 receptors in the heart and lungs
• D. To lower blood glucose by stimulating the release of insulin

Correct answer: A

Rationale: ACE inhibitors lower blood pressure by blocking the conversion of angiotensin I to vasoconstrictor angiotensin II. Angiotensin II is a potent vasoconstrictor, and by inhibiting its formation, ACE inhibitors help dilate blood vessels, reduce blood pressure, and decrease the workload on the heart. Choice B is incorrect as it describes the mechanism of action of diuretics, not ACE inhibitors. Choice C is incorrect as it refers to the action of beta-blockers, not ACE inhibitors. Choice D is incorrect as it describes the mechanism of action of antidiabetic medications, not ACE inhibitors.

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