Nursing Elites

1. When teaching a client with a new prescription for spironolactone, which instruction should the nurse include?

• A. Increase your intake of potassium-rich foods.
• B. Avoid consuming grapefruit juice.
• C. Take the medication with food.
• D. Monitor for signs of hyperkalemia.

Correct answer: D

Rationale: The correct answer is to instruct the client to monitor for signs of hyperkalemia when taking spironolactone since it is a potassium-sparing diuretic. Hyperkalemia is a potential adverse effect due to the medication's mechanism of action. Advising the client to increase potassium-rich foods (Choice A) would be incorrect as it can further elevate potassium levels, which could lead to hyperkalemia. Avoiding grapefruit juice (Choice B) is not directly related to spironolactone use. Though taking the medication with food (Choice C) can help reduce gastrointestinal upset, it is not the most critical instruction when initiating spironolactone therapy.

2. The healthcare provider is evaluating the effects of care for a client with deep vein thrombosis (DVT). Which limb observations should the provider note as indicating the least success in meeting the outcome criteria for this problem?

• A. Pedal edema that is 3+
• B. Slight residual calf tenderness
• C. Skin warm, equal temperature in both legs
• D. Calf girth 1/8 inch larger than the unaffected limb

Correct answer: A

Rationale: Significant pedal edema, indicated by 3+, suggests ongoing or worsening venous insufficiency. This can be a sign that the care provided has not been effective in managing the deep vein thrombosis (DVT) and the associated complications. Monitoring and addressing pedal edema is crucial in the evaluation of DVT treatment outcomes and overall patient care. Choices B, C, and D are not indicative of the least success in meeting the outcome criteria for DVT. Slight residual calf tenderness, skin warmth, and a slightly larger calf girth do not necessarily point towards treatment failure or lack of improvement in DVT management.

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

• A. Take the medication with a full glass of water.
• B. Lie down for 30 minutes after taking the medication.
• C. Take the medication at bedtime.
• D. Avoid dairy products while taking the medication.

Correct answer: A

Rationale: When taking alendronate, it is important to take the medication with a full glass of water to prevent esophageal irritation. This helps ensure that the medication reaches the stomach and is properly absorbed. Lying down after taking alendronate can increase the risk of esophageal irritation, which is why it is recommended to stay upright for at least 30 minutes after taking the medication. Taking the medication at bedtime or avoiding dairy products are not specific instructions associated with alendronate administration. Therefore, the correct instruction to include is to take the medication with a full glass of water.

4. A client with known coronary artery disease (CAD) begins to experience chest pain while getting out of bed. What action should the nurse take?

• A. Obtain a prescription for pain medication.
• B. Have the client stop and lie back down in bed.
• C. Report the complaint to the healthcare provider.
• D. Instruct the client to continue getting out of bed and into a chair.

Correct answer: B

Rationale: When a client with CAD experiences chest pain, it indicates myocardial ischemia. The nurse should have the client stop the activity and lie back down in bed to reduce the heart's oxygen demand, decrease myocardial workload, and prevent further ischemia. This action helps in improving blood flow to the heart and can potentially alleviate the chest pain. Option A is incorrect as pain medication should not be the initial action for chest pain in CAD. Option C is incorrect because the nurse should first intervene directly to address the chest pain. Option D is incorrect as continuing the activity can worsen the myocardial ischemia and chest pain.

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

• A. Take the medication with food.
• B. Monitor for signs of hypokalemia.
• C. Take the medication at bedtime.
• D. Monitor for a dry cough.

Correct answer: D

Rationale: The correct answer is to monitor for a dry cough. Captopril is known to cause a persistent dry cough as a common side effect. If a dry cough develops, it should be reported to the healthcare provider promptly, as it may necessitate discontinuation of the medication. Choice A is incorrect because captopril is usually taken on an empty stomach. Choice B is incorrect as hypokalemia is not a common side effect of captopril. Choice C is incorrect as captopril is typically taken during the day and not specifically at bedtime.

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