Nursing Elites

1. During an admission assessment, a client informs the nurse that they take propylthiouracil (PTU) daily. Based on this information, the nurse suspects that the client has a history of:

• A. Myxedema
• B. Graves' disease
• C. Addison's disease
• D. Cushing's syndrome

Correct answer: B

Rationale: Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, including Graves' disease, which is characterized by an overactive thyroid gland. The client mentioning the daily use of PTU indicates that they likely have a history of Graves' disease, as this medication helps manage the condition by reducing the production of thyroid hormones. Therefore, the correct answer is B: Graves' disease. Choice A, Myxedema, is incorrect as it refers to a condition of severe hypothyroidism, the opposite of hyperthyroidism. Choices C and D, Addison's disease and Cushing's syndrome, respectively, are unrelated to the use of PTU or hyperthyroidism, making them incorrect choices.

2. A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness?

• A. Lung sounds
• B. Blood pressure
• C. Blood ammonia level
• D. Serum potassium level

Correct answer: C

Rationale: In portosystemic encephalopathy, the liver's ability to detoxify ammonia is impaired, leading to elevated blood ammonia levels, which can cause neurological symptoms such as encephalopathy. Lactulose is given to reduce ammonia levels by promoting its excretion through the bowel. Therefore, assessing the blood ammonia level is crucial to determine the effectiveness of lactulose therapy in managing portosystemic encephalopathy.

3. Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which of the following food items?

• A. Milk
• B. Water
• C. Apple juice
• D. Orange juice

Correct answer: D

Rationale: Iron absorption is enhanced by the presence of vitamin C. Orange juice is a good source of vitamin C, which can improve the absorption of iron when taken together. Therefore, administering iron supplements with orange juice is the best choice to optimize iron absorption for the child.

4. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?

• A. Tremors
• B. Dizziness
• C. Confusion
• D. Hallucinations

Correct answer: C

Rationale: Older clients are particularly vulnerable to central nervous system side effects of cimetidine. The most frequent side effect is confusion. It is crucial for nurses to be vigilant in monitoring for confusion as it can impact the client's safety and well-being. While tremors, dizziness, and hallucinations are possible side effects, confusion is the most common in older clients taking cimetidine.

5. A client with hyperlipidemia is prescribed atorvastatin (Lipitor). Which instruction should the nurse include in the teaching plan?

• A. Take the medication in the morning.
• B. Avoid consuming grapefruit juice.
• C. Increase your intake of dairy products.
• D. Take the medication with food.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the teaching plan is to advise the client to avoid consuming grapefruit juice. Grapefruit juice can increase the risk of atorvastatin (Lipitor) toxicity by inhibiting its metabolism. Atorvastatin is typically taken in the evening as cholesterol synthesis occurs at night. Increasing dairy intake is not specifically recommended for atorvastatin therapy, and the medication can be taken with or without food.

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