Nursing Elites

1. A healthcare professional is planning to administer IV Alteplase to a client who is demonstrating manifestations of a massive Pulmonary Embolism. Which of the following interventions should the healthcare professional plan to take?

• A. Administer IM Enoxaparin along with the Alteplase dose.
• B. Hold direct pressure on puncture sites for up to 30 min.
• C. Administer Aminocaproic acid IV prior to alteplase infusion.
• D. Prepare to administer Alteplase within 8 hr of manifestation onset.

Correct answer: B

Rationale: The correct intervention when administering IV Alteplase is to hold direct pressure on puncture sites for 10 to 30 minutes or until oozing of blood stops. This helps prevent bleeding complications associated with thrombolytic therapy. Administering IM Enoxaparin is not indicated with Alteplase, as it is an anticoagulant rather than a thrombolytic agent. Aminocaproic acid is not typically administered prior to alteplase infusion in the context of a massive Pulmonary Embolism. While timely administration of Alteplase is important, the specific timeframe within which it should be administered may vary based on the clinical situation, so a strict 8-hour window is not universally applicable.

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

• A. Take this medication only when experiencing chest pain.
• B. Store the medication in a cool, dry place.
• C. Apply the patch to a different site each time.
• D. Do not cut the patch regardless of your blood pressure.

Correct answer: C

Rationale: When using Nitroglycerin patches to treat angina, it is crucial to apply the patch to a different site each time. This practice helps prevent skin irritation and ensures proper absorption of the medication, optimizing its effectiveness in managing angina symptoms.

3. A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take?

• A. Obtain a blood specimen immediately prior to administering the next dose of medication.
• B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen.
• C. Ask the client to provide a urine specimen after the next dose of medication.
• D. Administer the medication and obtain a blood specimen 30 minutes later.

Correct answer: A

Rationale: To verify the trough levels of a medication accurately, the nurse should obtain a blood specimen immediately before administering the next dose of the medication. The trough level represents the lowest concentration of the medication in the bloodstream, typically right before the next dose is due. This timing ensures an accurate assessment of the drug's concentration in the body at its lowest point, aiding in determining the drug's effectiveness and potential toxicity levels. Choice B is incorrect because waiting for 24 hours would not provide the trough level. Choice C is incorrect as urine specimens are not used to measure trough levels. Choice D is incorrect as obtaining a blood specimen 30 minutes after administering the medication would not reflect the trough level.

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

• A. Take this medication at bedtime.
• B. Avoid sudden discontinuation of the medication.
• C. Increase your intake of sodium-rich foods.
• D. Avoid drinking grapefruit juice.

Correct answer: B

Rationale: The correct instruction for a client on Labetalol is to avoid sudden discontinuation of the medication. Labetalol is a beta-blocker that, if abruptly stopped, can lead to rebound hypertension and other cardiac issues. It is essential for patients to taper off this medication under medical supervision to prevent adverse effects.

5. A client has a new prescription for Dabigatran. Which of the following instructions should be included?

• A. Take the medication with food.
• B. Store the capsules in a pill organizer.
• C. Crush the medication before swallowing.
• D. Expect frequent headaches while taking this medication.

Correct answer: A

Rationale: The correct answer is A: 'Take the medication with food.' Taking Dabigatran with food is recommended to reduce gastrointestinal discomfort, a common side effect associated with this medication. Food can help minimize stomach irritation and improve tolerability. Choices B, C, and D are incorrect. Storing the capsules in a pill organizer (B) is a good practice for organization but not a specific instruction for this medication. Crushing the medication before swallowing (C) is not recommended for Dabigatran as it is available as a capsule and should be swallowed whole. Expecting frequent headaches while taking this medication (D) is not a common side effect of Dabigatran and should not be anticipated.

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