Nursing Elites

1. When educating a client about the use of risedronate to treat osteoporosis, which instruction should be included?

• A. Drink a full glass of water with each dose.
• B. Take the medication on an empty stomach.
• C. Remain upright for 30 minutes after taking the medication.
• D. Avoid lying down for at least 1 hour after taking the medication.

Correct answer: C

Rationale: The correct instruction for a client taking risedronate to treat osteoporosis is to remain upright for 30 minutes after taking the medication. This is important to prevent esophageal irritation, as risedronate can cause irritation if it remains in contact with the esophagus. By staying upright, the medication is more likely to reach the stomach quickly and reduce the risk of irritation to the esophagus. Choices A, B, and D are incorrect. Drinking a full glass of water is recommended, not milk, to help with swallowing the medication. Risedronate should be taken on an empty stomach, not with meals, to ensure proper absorption. Additionally, avoiding lying down for at least 1 hour after taking the medication helps prevent esophageal irritation.

2. A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse should reinforce which dietary instruction?

• A. Avoid foods high in vitamin K.
• B. Increase intake of dairy products.
• C. Limit intake of foods high in fiber.
• D. Increase protein intake.

Correct answer: A

Rationale: The correct answer is to avoid foods high in vitamin K. Clients taking warfarin (Coumadin) should maintain a consistent intake of vitamin K to keep the medication's effectiveness stable. Foods high in vitamin K, such as leafy greens, can interfere with the anticoagulant effects of warfarin. Therefore, it is crucial for clients to avoid these foods to ensure the therapeutic effects of warfarin. Choices B, C, and D are incorrect because increasing dairy products, limiting fiber intake, or increasing protein intake do not directly impact the effectiveness of warfarin therapy and are not necessary dietary modifications for clients on this medication.

3. The client is being taught about the use of sublingual nitroglycerin for chest pain. Which instruction should be provided?

• A. Swallow the tablet whole with water.
• B. Place the tablet under the tongue and let it dissolve.
• C. Chew the tablet and then swallow.
• D. Place the tablet between the cheek and gum.

Correct answer: B

Rationale: The correct method for administering sublingual nitroglycerin is to place the tablet under the tongue and allow it to dissolve. This route of administration facilitates rapid absorption of the medication into the bloodstream, enabling quick relief of chest pain associated with angina or heart conditions. Choice A is incorrect because sublingual nitroglycerin should not be swallowed whole. Choice C is wrong as chewing the tablet can lead to the rapid release of the drug, causing adverse effects like headaches or dizziness. Choice D is also incorrect as the tablet should not be placed between the cheek and gum, but under the tongue for proper absorption.

4. A client with chronic obstructive pulmonary disease (COPD) is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction should the nurse reinforce to ensure correct use?

• A. Inhale deeply and slowly after activating the MDI.
• B. Hold the breath for 5 seconds after inhaling the medication.
• C. Rinse the mouth immediately after using the MDI.
• D. Exhale fully before placing the mouthpiece in the mouth.

Correct answer: A

Rationale: Inhaling deeply and slowly after activating the MDI is the correct instruction to ensure effective delivery of the medication to the lungs. This technique helps the medication reach the lower airways where it can be most beneficial in managing COPD symptoms. Inhaling too quickly or not deeply enough may result in improper drug delivery and reduce the effectiveness of the treatment. Holding the breath for 5 seconds after inhaling the medication (Choice B) may not be necessary and could cause discomfort without additional benefits. Rinsing the mouth immediately after using the MDI (Choice C) is not necessary unless specified by the healthcare provider. Exhaling fully before placing the mouthpiece in the mouth (Choice D) is not ideal as it may result in inadequate medication delivery to the lungs.

5. The healthcare provider is teaching a client about the use of nitroglycerin patches for angina pectoris. Which instruction should the healthcare provider include?

• A. Apply the patch to the same site each day
• B. Remove the patch at bedtime to prevent tolerance
• C. Cover the patch with a bandage to keep it in place
• D. Rotate the application site every 24 hours

Correct answer: D

Rationale: Rotating the application site every 24 hours is crucial when using nitroglycerin patches to prevent skin irritation and ensure consistent absorption of the medication. By rotating the site, the risk of local skin reactions is reduced, and the effectiveness of the nitroglycerin patch is maintained. Applying the patch to the same site each day (Choice A) can lead to skin irritation. Removing the patch at bedtime (Choice B) is not necessary as long as the prescribed wearing schedule is followed. Covering the patch with a bandage (Choice C) is not recommended as it may interfere with proper absorption.

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