Nursing Elites

1. The nurse is reviewing the prescriber�s orders and notes that omeprazole has been order for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient�s record.

• A. Aspirin 81mg daily
• B. Clopidogrel (Plavix) 75mg daily
• C. Heparin 5000 units subQ q12hrs
• D. Metoprolol 50mg q8hrs

Correct answer: B

Rationale: For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided.

2. In the management of heart failure, which diuretic is preferred due to its demonstrated significant mortality reduction in patients with heart failure?

• A. Furosemide (Lasix)
• B. Hydrochlorothiazide (HydroDIURIL)
• C. Spironolactone (Aldactone)
• D. Mannitol (Osmitrol)

Correct answer: C

Rationale: Spironolactone, a potassium-sparing diuretic, is the preferred choice in heart failure due to its cardio-protective effect, leading to reduced mortality in patients with heart failure. It is used to manage both hypertension and edema, making it a valuable option in heart failure treatment.

3. What is the probable cause recognized by the nurse when a 5-year-old boy is admitted to the hospital with acute glomerulonephritis?

• A. Recovery from German measles 2 months ago
• B. Dysuria since the previous night
• C. A history of allergy
• D. A sore throat 2 weeks ago

Correct answer: D

Rationale: Acute glomerulonephritis typically develops 1 to 3 weeks after a streptococcal infection, such as a sore throat, which triggers an allergic-type response that affects the glomeruli's function. This immune response leads to inflammation and damage to the glomeruli, resulting in acute glomerulonephritis.

4. The healthcare provider should question an order for glucocorticoids in the treatment of a patient with what condition?

• A. Systemic fungal infection
• B. Diabetes Mellitus
• C. Myasthenia Gravis
• D. Glaucoma

Correct answer: A

Rationale: Glucocorticoids are contraindicated in the treatment of a patient with systemic fungal infection or in patients receiving live vaccines due to their immunosuppressive effects. Glucocorticoids can exacerbate fungal infections by suppressing the immune response. While caution is advised in patients with diabetes mellitus, myasthenia gravis, and glaucoma, the presence of a systemic fungal infection warrants questioning the use of glucocorticoids to prevent worsening of the fungal infection.

5. A post-op patient has an epidural infusion of morphine sulfate. The patient�s respiratory rate declines to 8 breaths/minute. Which medication would the nurse anticipate administering?

• A. Naloxone (Narcan)
• B. Acetylcysteine (Mucomyst)
• C. Methyprednisolone (Solu-Medrol)
• D. Protamine Sulfate

Correct answer: A

Rationale: Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

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