Nursing Elites

1. A client who was diagnosed with oral thrush calls the clinic saying the medication bottle broke and all of the medication was spilled. The client is requesting a refill order. The nurse should contact the health care provider about a refill for which medication?

• A. Ampicillin
• B. Ciprofloxacin
• C. Neomycin sulfate
• D. Nystatin

Correct answer: D

Rationale: Nystatin is the appropriate medication for treating oral thrush as it is an antifungal drug specifically used for fungal infections. It targets the fungus responsible for thrush, Candida, effectively. Therefore, the nurse should contact the healthcare provider to request a refill of Nystatin for the client.

2. A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigued and dizzy. Which instruction should the nurse provide?

• A. Avoid hazardous activities until symptoms subside
• B. Contact the healthcare provider immediately
• C. Continue taking the medication every day
• D. Stop taking the medication until the unpleasant side effects wear off

Correct answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to avoid hazardous activities until the symptoms of fatigue and dizziness subside. These side effects can impair the client's ability to engage in activities that require alertness and coordination, posing a risk for accidents. Contacting the healthcare provider immediately may not be necessary unless the symptoms worsen or persist. Continuing to take the medication every day without addressing the side effects can lead to further complications. Stopping the medication abruptly without healthcare provider guidance can also be risky and may not be necessary if the symptoms improve with time.

3. Which action should be taken to assess for analgesic tolerance in a client who is unable to communicate?

• A. Review the client's laboratory values for changes in peak and trough levels of the analgesic
• B. Prolong the interval between analgesic medication doses and monitor the client's vital signs
• C. Observe the client for the presence of pain behaviors before the next analgesic dose is due
• D. Ask family members to report behaviors suggesting that the client's pain has returned

Correct answer: C

Rationale: In clients who are unable to communicate, observing for pain behaviors is crucial in assessing analgesic tolerance. Changes in pain behaviors can indicate if the current analgesic regimen is effective or if tolerance has developed. Therefore, closely observing the client for pain behaviors before the next analgesic dose helps healthcare providers evaluate the client's response to pain management. Reviewing laboratory values may not directly reflect analgesic tolerance. Prolonging the interval between doses and monitoring vital signs may not provide direct information on analgesic tolerance. Relying solely on family members to report pain behaviors may not be as accurate or immediate as observing the client directly.

4. Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer's disease has been accomplished?

• A. Increased muscle strength and tone
• B. Fewer episodes of urinary incontinence
• C. Decreased confusion and improved mood
• D. Reversal of the disease process as evidenced by increased functioning

Correct answer: C

Rationale: The correct answer is C. Donepezil is a medication used for individuals with Alzheimer's disease. Its mechanism of action involves increasing acetylcholine levels by inhibiting its breakdown, which benefits cognitive function. The expected outcome of administering donepezil is a decrease in confusion and an improvement in mood due to the medication's impact on neurotransmitters. Choices A, B, and D are incorrect because donepezil does not primarily target muscle strength, urinary incontinence, or disease reversal; instead, it aims to slow down the progression of cognitive decline in Alzheimer's disease.

5. A client with rheumatoid arthritis is prescribed tofacitinib. What should the nurse include in the client's teaching plan?

• A. Avoid live vaccines while taking this medication.
• B. Take this medication with food to decrease gastrointestinal upset.
• C. Report any signs of infection to the healthcare provider.
• D. Avoid sunlight while taking this medication.

Correct answer: A

Rationale: Tofacitinib is an immunosuppressive medication used in rheumatoid arthritis. Patients taking tofacitinib should avoid live vaccines because the medication can weaken the immune system, making live vaccines potentially harmful. It is essential to educate the client on this to prevent any complications related to live vaccines during their treatment.

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