Question

The practical nurse (PN) notes that the heart rate of a client newly started on levothyroxine sodium has increased from 98 to 120 beats/minute since the initial dose was administered the previous day. Which action should the PN implement?

Answer 1

Correct Answers:

Hold the next dose of levothyroxine sodium and notify the charge nurse of the change in the client's heart rate.

Rationale :

♦️ Levothyroxine sodium is a synthetic thyroid hormone used to replace deficient thyroid hormone in clients with hypothyroidism.

♦️ An increase in heart rate from 98 to 120 beats/minute after starting therapy represents significant tachycardia and requires prompt evaluation.

♦️ Excessive thyroid hormone activity increases metabolic rate and sympathetic stimulation, which can produce tachycardia, palpitations, tremors, nervousness, and heat intolerance.

♦️ Cardiovascular stimulation is particularly concerning because levothyroxine can increase myocardial oxygen demand and cardiac workload.

♦️ The PN should hold the next dose until the client's condition and medication regimen can be evaluated rather than administering additional thyroid hormone.

♦️ The PN should promptly report the change in heart rate to the charge nurse, who can facilitate further assessment and provider notification.

♦️ Continued administration despite significant tachycardia could increase the risk for dysrhythmias, angina, or other cardiovascular complications.

♦️ Therefore, withholding the medication and reporting the new tachycardia is the safest nursing action.

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Answer 2

Correct Answers:

Monitor the client's respiratory rate and effort.

Rationale :

✏️ Diazepam is a benzodiazepine that can cause significant central nervous system and respiratory depression, especially when administered intravenously.

✏️ During treatment of status epilepticus, IV diazepam acts rapidly to stop seizure activity by enhancing the inhibitory effects of GABA in the central nervous system.

✏️ The most serious immediate adverse effect is respiratory depression, which can progress to hypoventilation, apnea, and inadequate oxygenation.

✏️ The PN should closely monitor the client's respiratory rate, depth, effort, oxygen saturation, and level of consciousness after administration.

✏️ Emergency airway equipment and oxygen should be readily available because respiratory compromise can occur rapidly after IV administration.

✏️ Monitoring breathing takes priority over other assessments because impairment of airway and breathing can become life-threatening within minutes.

✏️ The nurse should also watch for excessive sedation and hypotension, but these findings are secondary to the immediate respiratory risk.

✏️ Therefore, monitoring the client's respiratory rate and effort is the most important intervention after IV diazepam.

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Answer 3

Correct Answers:

Notify your healthcare provider immediately if vision or hearing loss occur.

Rationale :

✨ Sildenafil is a phosphodiesterase type 5 (PDE-5) inhibitor commonly prescribed for erectile dysfunction and certain forms of pulmonary hypertension.

✨ Rare but serious adverse effects include sudden vision loss and sudden hearing loss, which require immediate medical evaluation.

✨ Visual changes can be associated with nonarteritic anterior ischemic optic neuropathy (NAION), a potentially serious ocular complication.

✨ Sudden hearing impairment can occur with tinnitus or dizziness and should not be ignored.

✨ The client should stop sexual activity and seek prompt medical attention for concerning symptoms such as chest pain, severe dizziness, or fainting.

✨ The client should also seek immediate care for an erection lasting longer than 4 hours, known as priapism, because permanent tissue damage can occur.

✨ Sildenafil should never be combined with nitrates, because the combination can cause a profound and potentially life-threatening decrease in blood pressure.

✨ Therefore, instructing the client to immediately report vision or hearing loss is essential medication-safety teaching.

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Answer 4

Correct Answers:

Signs of inflammation are reduced.

Rationale :

✳️ Corticosteroids have potent anti-inflammatory and immunosuppressive effects, making reduced inflammation an expected therapeutic response.

✳️ These medications decrease the production and activity of multiple inflammatory mediators, including cytokines and prostaglandins.

✳️ Successful corticosteroid therapy can reduce manifestations such as redness, swelling, warmth, tenderness, and pain caused by inflammation.

✳️ Corticosteroids also decrease capillary permeability, which helps reduce tissue edema at sites of inflammation.

✳️ The PN should compare the client's current inflammatory manifestations with baseline findings to determine whether treatment is effective.

✳️ Improvement depends on the underlying disorder, but a reduction in inflammatory signs and symptoms demonstrates the intended pharmacologic action.

✳️ Long-term or high-dose corticosteroid therapy requires monitoring because suppression of inflammation is accompanied by immune-system suppression and other systemic effects.

✳️ Therefore, reduced signs of inflammation provide the clearest evidence that the oral corticosteroid is producing its desired effect.

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Answer 5

Correct Answers:

Double the dose if a dose is missed.

Rationale :

💎 Allopurinol is a xanthine oxidase inhibitor used to decrease uric acid production, commonly for long-term management of gout and hyperuricemia.

💎 A client should never double the dose of allopurinol to compensate for a missed dose because this can increase the risk of adverse effects.

💎 If a dose is missed, the client should generally take it when remembered unless it is nearly time for the next scheduled dose.

💎 Taking excessive allopurinol can increase the risk for gastrointestinal effects, hepatotoxicity, and serious hypersensitivity reactions.

💎 The client should be particularly alert for rash, because it can be an early manifestation of a potentially severe allopurinol hypersensitivity reaction.

💎 Allopurinol is intended for prevention and long-term control of hyperuricemia, rather than immediate relief of an acute gout attack.

💎 Consistent administration according to the prescribed schedule helps maintain appropriate serum uric acid levels.

💎 Therefore, the statement about doubling a missed dose requires additional teaching.

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Answer 6

Correct Answers:

Antiemetic.

Rationale :

⚽ An antiemetic is a medication specifically used to prevent or relieve nausea and vomiting.

⚽ When a client reports nausea, the PN should review the PRN prescriptions and administer the prescribed antiemetic when appropriate.

⚽ Antiemetics work through various mechanisms involving the vomiting center, chemoreceptor trigger zone, gastrointestinal tract, or vestibular system.

⚽ Common antiemetics include ondansetron, promethazine, prochlorperazine, and metoclopramide, depending on the underlying cause and prescription.

⚽ Relieving nausea can improve the client's comfort, oral intake, hydration, and medication tolerance.

⚽ The PN should assess the severity and possible cause of the nausea before and after administering the medication.

⚽ The client should also be monitored for medication-specific adverse effects such as sedation, dizziness, or changes in gastrointestinal motility.

⚽ Therefore, the prescribed PRN antiemetic is the appropriate medication for a client experiencing nausea.

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Answer 7

Correct Answers:

Teach the client to use a straw when taking the medication to reduce further tooth staining.

Rationale :

🎯 Liquid iron preparations can cause temporary dark staining of the teeth when the medication repeatedly comes into direct contact with tooth enamel.

🎯 Using a straw helps direct the liquid toward the back of the mouth and reduces contact between the iron preparation and the teeth.

🎯 The client can also dilute the prescribed liquid iron in an appropriate fluid when permitted and take it promptly rather than sipping it slowly.

🎯 Good oral hygiene after administration can further decrease staining of the teeth.

🎯 The client can rinse the mouth or brush the teeth after taking the medication according to appropriate medication instructions.

🎯 Tooth discoloration from liquid iron is primarily a local effect and does not indicate that the medication must be discontinued.

🎯 The PN should reinforce correct administration techniques so the client can continue receiving the therapeutic benefits of iron replacement while minimizing staining.

🎯 Therefore, teaching the client to take liquid iron through a straw is the appropriate intervention.

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Answer 8

Correct Answers:

Fading and flattening of lesion surfaces.

Rationale :

🌼 Tinea capitis is a fungal infection of the scalp and hair follicles that requires appropriate antifungal therapy.

🌼 Effective treatment results in progressive resolution of the infection and improvement in the appearance of the affected scalp lesions.

🌼 Fading of the lesions indicates that inflammation and fungal activity are decreasing.

🌼 Flattening of the lesion surfaces also demonstrates healing because active fungal lesions tend to be raised, inflamed, or scaly.

🌼 Other manifestations such as itching, scaling, redness, and tenderness should gradually decrease as treatment becomes effective.

🌼 Hair growth can eventually resume as the infection resolves, although restoration of normal hair may take additional time.

🌼 The client should complete the entire prescribed course of oral antifungal medication, even when the lesions begin to improve.

🌼 Therefore, fading and flattening of the lesion surfaces provide the best evidence that antifungal therapy is effective.

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Answer 9

Correct Answers:

Hemoglobin.

Rationale :

🌻 Darbepoetin alfa is an erythropoiesis-stimulating agent used to treat anemia associated with chronic kidney disease (CKD).

🌻 CKD reduces the kidneys' production of erythropoietin, resulting in decreased red blood cell production and anemia.

🌻 Darbepoetin acts like endogenous erythropoietin by stimulating the bone marrow to produce red blood cells.

🌻 As red blood cell production increases, the client's hemoglobin level should gradually increase, demonstrating a therapeutic response.

🌻 Monitoring hemoglobin helps determine whether the medication is effective and whether dosage adjustments might be required.

🌻 Hemoglobin must also be monitored carefully because an excessive increase can raise the risk for hypertension, thromboembolic events, stroke, and cardiovascular complications.

🌻 Adequate iron stores are also necessary for an optimal response because iron is required for effective erythropoiesis.

🌻 Therefore, the serum hemoglobin level is the most important laboratory value for evaluating the effectiveness of darbepoetin alfa.

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Answer 10

Correct Answers

Blank 1 Correct Option: Angiotensin-converting enzyme inhibitor (ACE-I)
Blank 2 Correct Option: Vasodilation.

Rationale :

✅ Angiotensin-converting enzyme inhibitor (ACE-I)

❤️ Captopril belongs to the medication class known as angiotensin-converting enzyme inhibitors (ACE inhibitors).

❤️ ACE inhibitors block the enzyme responsible for converting angiotensin I into angiotensin II.

❤️ Angiotensin II is a potent vasoconstrictor that normally causes blood vessels to narrow and increases blood pressure.

❤️ Blocking its formation decreases systemic vascular resistance, helping lower the client's blood pressure.

❤️ ACE inhibition also decreases secretion of aldosterone, which reduces sodium and water retention.

❤️ Captopril is commonly prescribed for hypertension and can also be beneficial in selected clients with diabetes because of its renal protective effects, particularly when albuminuria is present.

❤️ The nurse should monitor blood pressure, renal function, and serum potassium during therapy.

❤️ Therefore, captopril is correctly classified as an angiotensin-converting enzyme inhibitor (ACE-I).

✅ Vasodilation

❤️ Captopril lowers blood pressure primarily by reducing formation of angiotensin II, resulting in vasodilation.

❤️ Vasodilation causes blood vessels to relax and widen, decreasing resistance against which the heart must pump.

❤️ Reduced systemic vascular resistance produces a decrease in arterial blood pressure.

❤️ Decreased angiotensin II also reduces aldosterone secretion, contributing to decreased sodium and water retention.

❤️ The client's persistently elevated blood pressure explains why an additional antihypertensive medication has been prescribed.

❤️ Blood pressure should be monitored closely, particularly after beginning therapy, because excessive vasodilation can cause hypotension and dizziness.

❤️ This client is also taking spironolactone, so serum potassium requires careful monitoring because both medications can increase the risk for hyperkalemia.

❤️ Therefore, vasodilation best describes the mechanism listed through which captopril lowers blood pressure.

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QLexNursing

1 :
The practical nurse (PN) notes that the heart rate of a client newly started on levothyroxine sodium has increased from 98 to 120 beats/minute since the initial dose was administered the previous day. Which action should the PN implement?

2 :
A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

3 :
A client receives a new prescription for sildenafil. Which instruction should the practical nurse (PN) reinforce with the client?

4 :
Prior to administering an oral corticosteroid, the practical nurse (PN) assesses the client. Which finding indicates the medication is producing the desired effect?

5 :
A client receives a prescription for allopurinol. Which information provided by the client requires additional reinforcement of instruction by the practical nurse (PN)?

6 :
When a male client tells the nurse that he is feeling nauseated, which PRN medication should the practical nurse (PN) administer?

7 :
A female client taking a liquid iron preparation expresses concern that her tooth colour has darkened since starting the medication. Which action should the practical nurse (PN) implement?

8 :
The practical nurse (PN) is evaluating the effects of an oral antifungal medication administered to a client with Tinea capitis. Which finding indicates that the medication is effective?

9 :
The practical nurse (PN) administered darbepoetin alfa to a client with chronic kidney disease (CKD). Which serum laboratory value should the PN monitor to evaluate the effectiveness of this drug?

10 :
The healthcare provider (HCP) has given the client a prescription for captopril.

Correct Answers

QLexNursing

1 : The practical nurse (PN) notes that the heart rate of a client newly started on levothyroxine sodium has increased from 98 to 120 beats/minute since the initial dose was administered the previous day. Which action should the PN implement?

2 : A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

3 : A client receives a new prescription for sildenafil. Which instruction should the practical nurse (PN) reinforce with the client?

4 : Prior to administering an oral corticosteroid, the practical nurse (PN) assesses the client. Which finding indicates the medication is producing the desired effect?

5 : A client receives a prescription for allopurinol. Which information provided by the client requires additional reinforcement of instruction by the practical nurse (PN)?

6 : When a male client tells the nurse that he is feeling nauseated, which PRN medication should the practical nurse (PN) administer?

7 : A female client taking a liquid iron preparation expresses concern that her tooth colour has darkened since starting the medication. Which action should the practical nurse (PN) implement?

8 : The practical nurse (PN) is evaluating the effects of an oral antifungal medication administered to a client with Tinea capitis. Which finding indicates that the medication is effective?

9 : The practical nurse (PN) administered darbepoetin alfa to a client with chronic kidney disease (CKD). Which serum laboratory value should the PN monitor to evaluate the effectiveness of this drug?

10 : The healthcare provider (HCP) has given the client a prescription for captopril.

Correct Answers

1 :
The practical nurse (PN) notes that the heart rate of a client newly started on levothyroxine sodium has increased from 98 to 120 beats/minute since the initial dose was administered the previous day. Which action should the PN implement?

2 :
A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

3 :
A client receives a new prescription for sildenafil. Which instruction should the practical nurse (PN) reinforce with the client?

4 :
Prior to administering an oral corticosteroid, the practical nurse (PN) assesses the client. Which finding indicates the medication is producing the desired effect?

5 :
A client receives a prescription for allopurinol. Which information provided by the client requires additional reinforcement of instruction by the practical nurse (PN)?

6 :
When a male client tells the nurse that he is feeling nauseated, which PRN medication should the practical nurse (PN) administer?

7 :
A female client taking a liquid iron preparation expresses concern that her tooth colour has darkened since starting the medication. Which action should the practical nurse (PN) implement?

8 :
The practical nurse (PN) is evaluating the effects of an oral antifungal medication administered to a client with Tinea capitis. Which finding indicates that the medication is effective?

9 :
The practical nurse (PN) administered darbepoetin alfa to a client with chronic kidney disease (CKD). Which serum laboratory value should the PN monitor to evaluate the effectiveness of this drug?

10 :
The healthcare provider (HCP) has given the client a prescription for captopril.