Nursing Elites

1. A client with schizophrenia is being taught strategies to cope with anticholinergic effects of Fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects?

• A. Take the medication in the morning to prevent insomnia.
• B. Chew sugarless gum to moisten the mouth.
• C. Use cooling measures to decrease fever.
• D. Take an antacid to relieve nausea.

Correct answer: B

Rationale: Chewing sugarless gum is an effective strategy to manage dry mouth, a common anticholinergic effect of Fluphenazine. By stimulating saliva production, sugarless gum helps to moisten the mouth and alleviate the discomfort associated with dryness. This intervention can improve the client's oral health and overall comfort while taking the medication. The other options are not directly related to alleviating anticholinergic effects. Taking the medication in the morning to prevent insomnia does not address anticholinergic effects specifically. Using cooling measures to decrease fever is not relevant to managing dry mouth caused by anticholinergic effects. Taking an antacid to relieve nausea is unrelated to managing dry mouth, which is the focus of anticholinergic effects.

2. Which of the following diuretics inhibits sodium reabsorption in the kidneys while sparing K+ and hydrogen ions?

• A. Spironolactone
• B. Furosemide
• C. Hydrochlorothiazide
• D. Bumetanide

Correct answer: A

Rationale: Spironolactone is the correct answer as it is classified as a potassium-sparing diuretic. It works by inhibiting sodium reabsorption in the kidneys while promoting the retention of potassium and hydrogen ions. This mechanism of action helps in reducing fluid retention without causing excessive loss of potassium, which is a common side effect of other diuretics. Furosemide (choice B), Hydrochlorothiazide (choice C), and Bumetanide (choice D) are not correct as they are not potassium-sparing diuretics. Furosemide and Bumetanide are loop diuretics that inhibit sodium, potassium, and chloride reabsorption in the loop of Henle. Hydrochlorothiazide is a thiazide diuretic that inhibits sodium and chloride reabsorption in the distal convoluted tubule, leading to potassium loss.

3. A client is starting a course of Metronidazole to treat an infection. For which of the following adverse effects should the client stop taking Metronidazole and notify the provider?

• A. Metallic taste
• B. Nausea
• C. Ataxia
• D. Dark-colored urine

Correct answer: C

Rationale: The correct answer is C, 'Ataxia.' Ataxia is a sign of central nervous system (CNS) toxicity, which can be a severe adverse effect of Metronidazole. Metallic taste and nausea are common side effects of Metronidazole but do not require stopping the medication unless they persist or worsen. Dark-colored urine is not typically associated with Metronidazole and does not indicate a severe adverse effect.

4. When instructing a client with a new prescription for Timolol on how to insert eye drops, which area should the nurse instruct the client to press on to prevent systemic absorption of the medication?

• A. Bony orbit
• B. Nasolacrimal duct
• C. Conjunctival sac
• D. Outer canthus

Correct answer: B

Rationale: Pressing on the nasolacrimal duct, located near the inner corner of the eye, blocks the lacrimal punctum and prevents the medication from entering the systemic circulation. This technique helps to ensure the medication stays localized in the eye, enhancing its therapeutic effect while minimizing systemic side effects. Choices A, C, and D are incorrect. The bony orbit is the eye socket and not a site to press for preventing systemic absorption. The conjunctival sac is where eye drops are instilled, not pressed on. The outer canthus is also not the correct area to press to prevent systemic absorption.

5. When a client is discharged with nitroglycerin (Nitrostat), what should the nurse include in client education?

• A. “Your chest pain should go away with one tablet.”
• B. “If your chest pain doesn’t go away after three tablets, call 911; you might be having a heart attack.”
• C. “If your chest pain doesn’t go away with one tablet, you can repeat the dose as many times as you need to.”
• D. “Be sure to call 911 before you take any tablets.”

Correct answer: B

Rationale: The correct answer instructs the client on the appropriate use of nitroglycerin. Nitroglycerin is used to relieve chest pain or angina. If the chest pain does not subside after taking one tablet, the client should take a maximum of three tablets at 5-minute intervals. If the pain persists after three tablets, it could indicate a heart attack, and emergency medical help should be sought. This education is crucial to ensure the client knows when to seek immediate medical attention.

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