Nursing Elites

1. A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by:

• A. Telling the client not to take the medication with food
• B. Suggesting that the client taper the dose until taste returns to normal
• C. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months
• D. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor

Correct answer: C

Rationale: The correct answer is to inform the client that impaired taste is an expected side effect of ACE inhibitors like fosinopril, such as Monopril, and typically resolves within 2 to 3 months. It is essential for the nurse to offer reassurance and education to the client about this common side effect to alleviate distress and encourage compliance with the medication regimen.

2. A client with chronic pain is prescribed transdermal fentanyl (Duragesic) patches. Which instruction should the nurse include in the teaching plan?

• A. Apply the patch to a different site each time.
• B. Avoid using heating pads over the patch.
• C. Change the patch every 72 hours.
• D. Remove the old patch before applying the new one.

Correct answer: B

Rationale: Clients using transdermal fentanyl (Duragesic) patches should avoid using heating pads over the patch as heat can increase the release of the medication, potentially leading to overdose. The patch should be applied to a different site each time, changed every 72 hours, and the old patch should be removed before applying a new one to prevent accidental overdose or excessive drug absorption.

3. A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to:

• A. Count the radial and carotid pulses every morning.
• B. Check the blood pressure every morning and evening.
• C. Stop taking the medication if the pulse is higher than 100 beats per minute.
• D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

Correct answer: D

Rationale: When taking digoxin, monitoring the pulse rate is essential due to its potential effects on heart rate. Digoxin can lead to bradycardia, where the pulse rate drops significantly. Withholding the medication and promptly contacting the healthcare provider if the pulse falls below 60 beats per minute is crucial to prevent severe complications and ensure appropriate management. Choices A, B, and C are incorrect because counting radial and carotid pulses, checking blood pressure, or stopping the medication based on a pulse rate higher than 100 beats per minute are not the primary monitoring parameters for a client taking digoxin.

4. While taking trimethoprim-sulfamethoxazole (TMP-SMZ), a client should be instructed to report which symptom if it develops during the course of this medication therapy?

• A. Nausea
• B. Diarrhea
• C. Headache
• D. Sore throat

Correct answer: D

Rationale: Clients prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) should be educated about potential blood disorders associated with the medication. Early signs of these disorders include symptoms like sore throat, fever, and pallor. If the client experiences any of these symptoms, they should promptly notify their healthcare provider. Nausea, diarrhea, and headache are common side effects of TMP-SMZ that usually do not require immediate medical attention.

5. A healthcare professional is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the healthcare professional to check before administering the medication?

• A. Heart rate
• B. Temperature
• C. Respirations
• D. Blood pressure

Correct answer: A

Rationale: Before administering digoxin, it is essential to assess the client's heart rate as this medication directly affects cardiac function. Monitoring the heart rate helps identify if it is within the acceptable range for administering digoxin. A pulse rate below 60 beats per minute warrants withholding the medication to prevent potential adverse effects like bradycardia or cardiac arrhythmias.

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