Nursing Elites

1. The healthcare professional is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The healthcare professional will request an order for

• A. a decreased dose of TMP-SMX.
• B. a different antibiotic.
• C. an increased dose of warfarin.
• D. coagulation studies.

Correct answer: D

Rationale: Sulfonamides, like trimethoprim-sulfamethoxazole (TMP-SMX), can potentiate the anticoagulant effects of warfarin (Coumadin). To monitor the patient's response and prevent adverse effects, the healthcare professional should request coagulation studies, such as International Normalized Ratio (INR) levels. Choosing a decreased dose of TMP-SMX would not address the potential drug interaction between TMP-SMX and warfarin. Opting for a different antibiotic is not necessary if the interaction can be managed by monitoring. Increasing the dose of warfarin without monitoring could lead to excessive anticoagulation and adverse events, so it's not the appropriate action in this scenario.

2. To evaluate the positive effect of furosemide (Lasix) 40 mg/day in a client with chronic kidney disease (CKD), what is the best action for the nurse to take?

• A. Obtain daily weights of the client.
• B. Auscultate heart and breath sounds.
• C. Palpate the client’s abdomen.
• D. Assess the client’s diet history.

Correct answer: A

Rationale: The correct answer is A. Furosemide (Lasix) is a loop diuretic used to manage fluid overload and hypertension in clients with CKD. Monitoring daily weights is crucial as weight changes reflect fluid status. Each kilogram of weight change approximately corresponds to 1 liter of fluid retention or loss, making it essential for evaluating the medication's effectiveness. Auscultating heart and breath sounds is more relevant for heart failure cases with fluid retention, not specifically for assessing the effect of furosemide in CKD. Palpating the abdomen is not a direct indicator of furosemide's effectiveness; instead, assessing for edema would be appropriate. While assessing the client's diet history is important to monitor electrolyte balance due to potassium loss with furosemide, it does not directly evaluate the medication's efficacy.

3. A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent claudication. The nurse determines this medication is effective when the client reports which of the following?

• A. I am having fewer aches and pains.
• B. I do not have headaches anymore.
• C. I am able to walk further without leg pain.
• D. My toes are turning grayish black in color.

Correct answer: C

Rationale: The correct answer is C. Cilostazol improves blood flow to the muscles, which helps alleviate symptoms of intermittent claudication. An improvement in walking distance without leg pain indicates the effectiveness of the medication. Choices A and B are not directly related to the expected outcome of Cilostazol therapy for intermittent claudication. Choice D is concerning for a potential adverse effect and should be reported to the healthcare provider immediately.

4. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?

• A. Albumin level of 2.5 g/dL
• B. Phosphorus level of 5 mg/dL
• C. Sodium level of 135 mmol/L
• D. Potassium level of 5.5 mmol/L

Correct answer: A

Rationale: In chronic renal failure, a protein-restricted diet is crucial to prevent the buildup of waste products. A low albumin level (<3.5 g/dL) indicates inadequate protein intake, raising concern as it may lead to malnutrition and tissue breakdown. Phosphorus, sodium, and potassium levels are not directly impacted by protein intake. Phosphorus levels may elevate in renal failure, but at 5 mg/dL, it is within normal range. Sodium and potassium levels are also within normal limits and not influenced by protein restriction.

5. A client who has just undergone surgery suddenly experiences chest pain, dyspnea, and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately sets about:

• A. Preparing the client for a perfusion scan
• B. Attaching the client to a cardiac monitor
• C. Administering oxygen via nasal cannula
• D. Ensuring that the intravenous (IV) line is patent

Correct answer: C

Rationale: When a client who has just undergone surgery experiences sudden chest pain, dyspnea, and tachypnea, indicating possible pulmonary embolism, the immediate priority for the nurse is to administer oxygen via nasal cannula. This intervention aims to improve oxygenation and alleviate respiratory distress, which is crucial in the setting of a potential pulmonary embolism. Preparing the client for a perfusion scan is not the immediate priority as stabilizing the client's respiratory status comes first. While attaching the client to a cardiac monitor is important for monitoring, administering oxygen takes precedence in this situation. Ensuring IV line patency is relevant for overall client care but is not the priority when a client is experiencing respiratory distress requiring immediate intervention.

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