Nursing Elites

1. A client is prescribed phenytoin for the management of seizures. What instruction should the practical nurse provide to the client regarding this medication?

• A. Take the medication at the same time every day.
• B. Discontinue the medication if a rash develops.
• C. Avoid consuming dairy products.
• D. Monitor blood pressure regularly.

Correct answer: A

Rationale: The correct instruction the practical nurse should provide to the client regarding phenytoin is to take the medication at the same time every day. This consistency helps maintain a steady level of the medication in the bloodstream, which is crucial for effectively managing seizures. It is important for clients to adhere to their prescribed dosing schedule to optimize the therapeutic benefits of phenytoin. Choices B, C, and D are incorrect because discontinuing the medication without healthcare provider guidance can be dangerous, there is no specific interaction between phenytoin and dairy products, and monitoring blood pressure is not a primary concern with phenytoin therapy for seizures.

2. A client diagnosed with seizures is prescribed phenytoin. Which medication instruction should the practical nurse (PN) reinforce to this client?

• A. Maintain consistent sodium intake.
• B. Use sunscreen when outdoors.
• C. Return for monthly urinalysis.
• D. Brush and floss teeth daily.

Correct answer: D

Rationale: The correct answer is to reinforce the instruction to brush and floss teeth daily. Phenytoin therapy can lead to gingival hyperplasia (gum disease), which can be prevented by maintaining good oral hygiene practices such as brushing and flossing daily. Choices A, B, and C are incorrect because they are not directly related to the side effects or management of phenytoin therapy. Maintaining consistent sodium intake is not a specific concern with phenytoin. Using sunscreen when outdoors is important to prevent sunburn but is not directly related to phenytoin therapy. Returning for monthly urinalysis may be necessary for other medications, but it is not specifically required for monitoring phenytoin therapy.

3. A client with diabetes mellitus is prescribed insulin glargine. What information should the practical nurse (PN) provide to the client about this medication?

• A. Administer the insulin at mealtimes.
• B. Do not mix this insulin with other insulins.
• C. Shake the vial well before use.
• D. Store the insulin in the freezer.

Correct answer: B

Rationale: Insulin glargine is a long-acting insulin that should not be mixed with other insulins in the same syringe. Mixing it with other insulins can alter its pharmacokinetics and effectiveness. Insulin glargine is usually administered at the same time each day, often at bedtime, to provide a consistent basal level of insulin over 24 hours.

4. A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

• A. Dilute the available heparin in 250ml of normal saline solution prior to IV administration
• B. Advise the pharmacy on the need to deliver a vial of heparin to the nursing unit immediately
• C. Calculate and administer the equivalent dose of the available low molecular weight heparin
• D. Request a prescription to change the route of administration and use the available heparin

Correct answer: B

Rationale: In this scenario, the nurse should contact the pharmacy to obtain the correct heparin formulation as the prescription calls for heparin 1,000 units IV STAT. Low molecular weight heparin is not the same as unfractionated heparin, and therefore, the nurse should not administer the available low molecular weight heparin without first obtaining the correct medication. Diluting the available heparin, calculating an equivalent dose, or changing the route of administration would not address the discrepancy between the prescribed heparin and the available low molecular weight heparin.

5. How does omeprazole work in treating a peptic ulcer?

• A. Increasing the production of gastric acid
• B. Neutralizing stomach acid
• C. Coating the stomach lining
• D. Reducing gastric acid secretion

Correct answer: D

Rationale: Omeprazole is a proton pump inhibitor that works by reducing gastric acid secretion. By inhibiting the enzyme responsible for pumping acid into the stomach, omeprazole helps decrease the acidity level in the stomach, providing relief from peptic ulcers. Option A is incorrect because omeprazole does not increase gastric acid production; instead, it decreases it. Option B is incorrect as omeprazole does not neutralize existing stomach acid but rather reduces its secretion. Option C is incorrect as omeprazole does not coat the stomach lining but acts on reducing acid secretion.

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