Nursing Elites

1. A client has a new prescription for Warfarin. The nurse should identify that the concurrent use of which of the following medications increases the client's risk of bleeding?

• A. Vitamin K
• B. Calcium carbonate
• C. Acetaminophen
• D. Ranitidine

Correct answer: C

Rationale: The correct answer is Acetaminophen (Choice C). Acetaminophen, especially in high doses, can increase the risk of bleeding in clients taking Warfarin. It can potentiate the anticoagulant effect of Warfarin, leading to an increased risk of bleeding. Vitamin K (Choice A) is actually used to reverse the effects of Warfarin in case of over-anticoagulation, so it does not increase the risk of bleeding. Calcium carbonate (Choice B) and Ranitidine (Choice D) do not significantly interact with Warfarin to increase the risk of bleeding.

2. A client has a new prescription for Sucralfate to treat a duodenal ulcer. Which of the following instructions should be included?

• A. Take the medication with meals.
• B. Swallow the tablet whole.
• C. Take the medication 1 hour before meals.
• D. Chew the tablet before swallowing.

Correct answer: C

Rationale: The correct instruction for taking Sucralfate is to take it 1 hour before meals. This timing allows the medication to coat the stomach lining, providing a protective barrier against stomach acid, which aids in healing the duodenal ulcer. Option A is incorrect as it contradicts the correct timing for taking Sucralfate. Option B is not necessary as it does not pertain to how the medication should be taken in relation to meals. Option D is incorrect as chewing the tablet before swallowing is not the correct administration method for Sucralfate.

3. A client has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should be taken to obtain an accurate gentamicin serum level?

• A. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose.
• B. Draw a peak level 90 min prior to administering the medication and a trough level 90 min after the dose.
• C. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose.
• D. Draw a peak level at 0900 and a trough level at 2100.

Correct answer: C

Rationale: To obtain an accurate gentamicin serum level, the trough should be drawn immediately before administering the medication, and the peak level should be drawn 30 minutes after the dose. This timing allows for the assessment of the lowest and highest drug concentrations in the bloodstream, ensuring therapeutic levels are achieved while minimizing the risk of toxicity. Choice A is correct as it follows this timing protocol. Choices B and D have incorrect timing for peak and trough levels, which would not provide an accurate representation of the drug's concentration in the bloodstream.

4. A client has a new prescription for a Fentanyl transdermal patch. Which of the following instructions should the nurse include?

• A. Apply the patch to a non-hairy area.
• B. Change the patch every 72 hours.
• C. Avoid exposure to heat sources.
• D. Do not cut the patch to adjust the dosage.

Correct answer: C

Rationale: The correct instruction the nurse should include for a client using a Fentanyl transdermal patch is to avoid exposure to heat sources. Heat can increase the absorption of the medication, potentially causing an overdose. Instructing the client to avoid heat sources is crucial to ensure their safety and the effectiveness of the medication. Choices A, B, and D are incorrect because applying the patch to a non-hairy area, changing it every 72 hours, and not cutting the patch are general guidelines for using transdermal patches but do not specifically address the unique risks associated with Fentanyl patches.

5. A healthcare provider is caring for a group of individuals who are not immune to Varicella. The healthcare provider should prepare to administer the Varicella vaccine at this time to which of the following individuals?

• A. 24-year-old woman in the third trimester of pregnancy
• B. 12-year-old child who has a severe allergy to neomycin
• C. 2-month-old infant who has no health problems
• D. 32-year-old man who has essential hypertension

Correct answer: D

Rationale: The correct answer is the 32-year-old man with essential hypertension. Individuals not immune to Varicella should receive the vaccine if they did not get two doses earlier. Essential hypertension is not a contraindication for the Varicella vaccine. Administering the vaccine to pregnant women, individuals with severe neomycin allergies, or infants is contraindicated. Pregnant women should not receive the Varicella vaccine due to the potential risk to the fetus. Severe neomycin allergies are a contraindication because neomycin is present in the vaccine. Infants under 12 months of age are generally not vaccinated against Varicella unless there are specific circumstances or recommendations.

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