Nokea
The 40-year-old client is receiving levothyroxine for treatment of hypothyroidism. Which serum laboratory results should lead the nurse to conclude that the client's dose is adequate?
- A. Thyroid-stimulating hormone and cortisol
- B. Thyroid-stimulating hormone and free T4
- C. Triiodothyronine (T3) and free thyroxine (T4)
- D. White blood cells, glucose, and potassium
Correct Answer: B
Rationale: A: Cortisol levels are used to evaluate adrenal and not thyroid function. B: Restoration of normal laboratory values for TSH and free T4 indicates that the dose of levothyroxine (Synthroid) is therapeutic. C: T3 is used to evaluate the effectiveness of liothyronine and propylthiouracil, used in the treatment of thyroid disorders. D: The WBC count is used to determine if the client has an infection. Evaluation of serum glucose and potassium levels is unrelated to the use of levothyroxine.
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The client has an order for a 1,000 mL bag of fluids to be infused over 8 hours. What is the correct rate?
- A. 100 mL/hr
- B. 125 mL/min
- C. 125 mL/hr
- D. 80 mL/min
Correct Answer: C
Rationale: The correct calculation is 1000 / 8 which equals 125 mL/hr.
A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate?
- A. I will call your physician to see if we can start some ginger.'
- B. We don't use home remedies in this clinic.'
- C. Herbs are not as effective as regular medicines.'
- D. Just eat some dry crackers instead.'
Correct Answer: A
Rationale: This statement reveals cultural sensitivity. Ginger is sometimes used to relieve nausea. The other statements are culturally insensitive and do not show an awareness of herbal pharmacology.
An LPN is reviewing medication lists for several clients recently admitted to the hospital. Which of the following scenarios would be least concerning?
- A. A client taking allopurinol for gout states they have been taking black cohosh to help with post-menopausal symptoms.
- B. A client has an order for warfarin and states they have been taking Ginkgo biloba to improve their memory.
- C. A client taking Lipitor states they have been taking ginseng for an energy boost.
- D. A client has a prescription for an SSRI and states they have been taking St. John's wort to also help with their depression.
Correct Answer: C
Rationale: Ginseng may cause an increased risk of bleeding but should not interact with Lipitor. St. John's wort should not be taken with an SSRI as it may cause serotonin syndrome. Black cohosh should not be taken with allopurinol as they can both cause hepatotoxicity, especially in combination. Ginkgo biloba should not be taken with warfarin as it causes an increased risk of bleeding.
The client with CRF is receiving epoetin alfa. Which finding should indicate to the nurse that the action of the medication has been effective?
- A. Urine output increased to 30 mL per hour
- B. Hemoglobin 12 g/dL and hematocrit 36%
- C. BP 110/70 mm Hg and heart rate 68 bpm
- D. Reports an increased energy level and less fatigue
Correct Answer: B
Rationale: A: Epoetin alfa does not have an effect on urine output or BP. B: Epoetin alfa stimulates erythropoiesis, or the production of RBCs. It is used in treating anemias associated with decreased RBC production, such as in renal failure. Hgb and Hct are used to evaluate the medication's effectiveness. The target Hgb for the client with CRF is 12 g/dL. C: Epoetin alfa does not have an effect on BP or HR. D: The client may report increased energy and less fatigue because of the increased Hgb levels, but these findings are not used to evaluate the medication's action.
The LPN is taking care of a client who is on Phenelzine (Nardil) for depression. Which meal would the nurse encourage the client to avoid?
- A. steak and potatoes
- B. prosciutto and cheese plate
- C. orange juice and toast
- D. carbonated water, shrimp and rice
Correct Answer: B
Rationale: Phenelzine (Nardil) is a type of MAOI (Monoamine Oxidase Inhibitor). Clients on these drugs should avoid foods and beverages with large amounts of tyramine, as they may cause dangerous elevations in blood pressure. Common foods high in tyramine include aged meats and cheeses, beer, sauerkraut, and soy sauce.