Nursing Elites

1. A client with asthma is prescribed fluticasone. The nurse should instruct the client to use this medication at which time?

• A. During an asthma attack
• B. Twice a day
• C. Once a day
• D. At night before bed

Correct answer: C

Rationale: Fluticasone is a maintenance medication for asthma aimed at controlling symptoms. It should be taken once a day on a regular basis to provide ongoing relief and prevent asthma symptoms, rather than being used to treat acute asthma attacks. Therefore, the correct answer is to use it once a day. Choices A, B, and D are incorrect because using fluticasone during an asthma attack, twice a day, or only at night before bed does not align with the medication's purpose of being a daily maintenance therapy.

2. An older adult with iron deficiency anemia is being discharged with iron supplements, which information should the nurse include in the discharge?

• A. Take the tablet with a daily multivitamin
• B. Crush the tablet and mix it with pudding
• C. Bedtime is the best time to take the tablet
• D. Wait 2 hours after meals to take the tablet

Correct answer: D

Rationale: The correct answer is to wait 2 hours after meals before taking the iron tablet. This is important to ensure better absorption and efficacy of the iron supplement. Taking the tablet with a daily multivitamin (Choice A) may interfere with iron absorption due to interactions with other minerals. Crushing the tablet and mixing it with pudding (Choice B) can alter the effectiveness of the medication. While bedtime (Choice C) may be convenient, waiting after meals is crucial for optimal iron absorption.

3. Prior to administration of the initial dose of the GI agent misoprostol, which information should the nurse obtain from the client?

• A. Taking an anti-emetic medication
• B. History of glaucoma
• C. Currently pregnant
• D. Allergy to aspirin

Correct answer: C

Rationale: The correct answer is C. It is crucial for the nurse to obtain information regarding the client's pregnancy status before administering misoprostol, as this medication is contraindicated in pregnancy due to its potential to cause uterine contractions. This can lead to serious complications such as miscarriage or premature birth. Therefore, assessing whether the client is currently pregnant is essential to ensure the safe administration of misoprostol. Choices A, B, and D are not directly related to the administration of misoprostol. While knowing if the client is taking an anti-emetic medication may be relevant to prevent drug interactions, a history of glaucoma and allergy to aspirin are not primary concerns before administering misoprostol.

4. A client with rheumatoid arthritis is prescribed methotrexate. The nurse should include which instruction in the client's teaching plan?

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

Correct answer: C

Rationale: The correct instruction for a client prescribed methotrexate is to avoid sunlight while taking this medication. Methotrexate can increase sensitivity to sunlight, leading to skin reactions. It is essential for clients to limit sun exposure and use protective measures like sunscreen and clothing coverage to prevent adverse effects. Choices A, B, and D are incorrect because avoiding alcohol, taking with food, and reporting signs of infection are not specific instructions related to methotrexate therapy.

5. 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.

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