Nursing Elites

1. A client with tobacco use disorder is being educated about Nicotine replacement therapy. Which statement by the client indicates an understanding of the teaching?

• A. I should avoid eating right before chewing a piece of nicotine gum.
• B. I will need to stop using the nicotine gum after 1 year.
• C. I know that nicotine gum is a safe alternative to smoking during pregnancy.
• D. I must chew the nicotine gum quickly for about 15 minutes.

Correct answer: A

Rationale: The correct answer is A. To maximize the effectiveness of nicotine gum, the client should avoid eating or drinking 15 minutes before and while using it. This helps ensure proper absorption of nicotine through the oral mucosa. Choice B is incorrect because the duration of nicotine gum use can vary depending on the individual's needs and progress. Choice C is incorrect as nicotine gum should be used during pregnancy only under healthcare provider guidance. Choice D is incorrect because nicotine gum should be chewed slowly until a tingling sensation is felt, then parked between the cheek and gum until the tingling stops.

2. A client reports taking Aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin?

• A. Digoxin
• B. Metformin
• C. Warfarin
• D. Nitroglycerin

Correct answer: C

Rationale: The correct answer is C, Warfarin. Aspirin increases the effect of anticoagulants like warfarin by inhibiting platelet aggregation, leading to an increased risk of bleeding. Therefore, the use of aspirin is generally contraindicated for clients taking warfarin. Choices A, B, and D are not contraindicated with aspirin. Digoxin, Metformin, and Nitroglycerin do not have significant interactions with Aspirin, unlike Warfarin, making them safe to use concomitantly.

3. 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.

4. A client with Schizophrenia is taking Risperidone. Which of the following instructions should the nurse include in the teaching?

• A. Increase your intake of snacks to prevent weight loss.
• B. Notify the provider if you develop breast enlargement.
• C. Be aware of the possibility of mild seizures while taking this medication.
• D. Expect an increase in libido when taking this medication.

Correct answer: B

Rationale: The correct instruction the nurse should provide to the client taking Risperidone for Schizophrenia is to notify the provider if they develop breast enlargement. Risperidone can lead to an increase in prolactin levels, causing gynecomastia (breast enlargement) and galactorrhea. Therefore, it is crucial for the client to report these manifestations to the healthcare provider for appropriate management. Choices A, C, and D are incorrect. Increasing snack intake to prevent weight loss is not a specific concern related to Risperidone. Mild seizures are not a common side effect of Risperidone, so this instruction is unnecessary. Risperidone is more likely to cause sexual side effects like decreased libido rather than an increase.

5. A healthcare professional is preparing to administer clindamycin 200 mg by intermittent IV bolus. The amount available is clindamycin injection 200 mg in 100 mL 0.9% sodium chloride (0.9% NaCl) to infuse over 30 min. How many mL/hr should the IV pump be set to deliver?

• A. 200 mL/hr
• B. 150 mL/hr
• C. 100 mL/hr
• D. 250 mL/hr

Correct answer: A

Rationale: To calculate the flow rate in mL/hr: (Volume in mL / Time in hours) = Flow rate in mL/hr. In this case, (100 mL / 0.5 hr) = 200 mL/hr. Therefore, the IV pump should be set to deliver 200 mL/hr to administer clindamycin 200 mg over 30 minutes. Choice A is correct because it provides the accurate flow rate needed for the administration of the medication. Choices B, C, and D are incorrect as they do not calculate the flow rate correctly based on the volume and time specified in the question.

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