Nursing Elites

1. The practical nurse administers lactulose to a client. Which client outcome would indicate a therapeutic response?

• A. An increase in urine output
• B. Two to three soft stools per day
• C. Absence of nausea
• D. Decreased serum potassium

Correct answer: B

Rationale: Lactulose is a type of laxative that works by preventing the absorption of ammonia in the colon, leading to increased water absorption in the stool and softening of the stool. The therapeutic response to lactulose is indicated by the passage of two to three soft stools per day, showing that the medication is effectively promoting bowel movements.

2. A client with diabetes mellitus type 2 is prescribed sitagliptin. The nurse should include which instruction in the client's teaching plan?

• A. Take this medication with meals.
• B. Avoid alcohol while taking this medication.
• C. Take this medication on an empty stomach.
• D. Report any signs of pancreatitis to the healthcare provider.

Correct answer: D

Rationale: The correct instruction to include in the teaching plan for a client prescribed sitagliptin is to report any signs of pancreatitis to the healthcare provider. Sitagliptin is generally taken with meals to reduce gastrointestinal side effects. Therefore, choice A, 'Take this medication with meals,' is incorrect. Sitagliptin does not have specific interactions with alcohol, so there is no need to advise the client to avoid alcohol, making choice B incorrect. Taking sitagliptin on an empty stomach is not recommended, so choice C is also incorrect. Pancreatitis is a rare but serious side effect of sitagliptin, so it is crucial for the client to report any signs or symptoms to their healthcare provider promptly.

3. When administering medications to a group of clients, which client should the nurse closely monitor for the development of acute kidney injury (AKI)?

• A. Lorazepam
• B. Sucralfate
• C. Digoxin
• D. Vancomycin

Correct answer: D

Rationale: Vancomycin is known to be nephrotoxic, which means it can cause damage to the kidneys. Therefore, clients receiving Vancomycin should be closely monitored for signs and symptoms of acute kidney injury (AKI) to ensure early detection and intervention if necessary. Lorazepam, Sucralfate, and Digoxin do not typically cause acute kidney injury, so they are not the priority for monitoring in this scenario.

4. During a home visit, a client with a history of angina reports frequent headaches. The client recently started a new prescription for diltiazem, a calcium channel blocker. What action should the nurse take?

• A. Explain the importance of obtaining a blood sample promptly to test for medication toxicity
• B. Consult with the healthcare provider regarding the necessity of an opioid analgesic for pain relief
• C. Recommend the client to discontinue the medication until contacting the healthcare provider
• D. Instruct the client on the use of acetaminophen every 4-6 hours as needed for headaches

Correct answer: D

Rationale: The correct action for the nurse to take is to instruct the client to use acetaminophen for headaches. Acetaminophen is a suitable and safer option for managing headaches associated with calcium channel blockers like diltiazem. It is essential to avoid medications that can interact negatively with diltiazem, such as opioid analgesics. Discontinuing the medication abruptly without consulting the healthcare provider is not recommended. Monitoring for medication toxicity through blood samples is not typically indicated for managing headaches in this scenario.

5. When a patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed ipratropium, the nurse should monitor for potential side effects. The correct answer is dry mouth. Ipratropium can cause dry mouth as a common side effect due to its anticholinergic effects. This side effect can impact the patient's oral health and comfort, requiring close monitoring and appropriate interventions.

• A. Dry mouth
• B. Tachycardia
• C. Insomnia
• D. Increased appetite

Correct answer: A

Rationale: Ipratropium is an anticholinergic medication commonly used in COPD. One of the most common side effects of anticholinergics is dry mouth due to the inhibition of salivary gland function. Tachycardia (Choice B) is not a typical side effect of ipratropium. Insomnia (Choice C) is also not a common side effect of this medication. Increased appetite (Choice D) is not associated with ipratropium use. Therefore, the correct side effect to monitor for in a patient prescribed ipratropium is dry mouth.

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