Nursing Elites

1. What instruction should be included in the client's teaching plan when prescribed montelukast (Singulair) for asthma?

• A. Take the medication as needed for asthma attacks.
• B. Take the medication in the evening.
• C. Increase fluid intake while taking this medication.
• D. Use the medication before exercise.

Correct answer: B

Rationale: The correct instruction to include in the teaching plan for a client prescribed montelukast (Singulair) is to take the medication in the evening. Montelukast is most effective when taken in the evening to provide optimal control of asthma symptoms. It is not intended for use as a rescue medication for asthma attacks. There is no specific recommendation to increase fluid intake or use the medication before exercise in relation to montelukast therapy.

2. The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times?

• A. With meals and at bedtime
• B. Every 6 hours around the clock
• C. One hour after meals and at bedtime
• D. One hour before meals and at bedtime

Correct answer: D

Rationale: Sucralfate is a gastric protectant that forms a protective coating over the ulcer. Administering sucralfate 1 hour before meals and at bedtime is important to create a barrier that protects the ulcer from gastric acid and mechanical irritation. This timing allows sucralfate to effectively coat the ulcer site and provide the desired therapeutic effect, enhancing its efficacy in promoting ulcer healing and symptom relief.

3. The healthcare provider is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The healthcare provider consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?

• A. Pancreatitis
• B. Diabetes mellitus
• C. Myocardial infarction
• D. Chronic obstructive pulmonary disease

Correct answer: A

Rationale: Asparaginase is contraindicated in clients with a history of pancreatitis due to the risk of impairing pancreatic function and causing complications. Therefore, the healthcare provider should consult with the registered nurse to assess the client's history of pancreatitis before administering asparaginase.

4. The healthcare provider should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be:

• A. Prednisone
• B. Sulfisoxazole
• C. Furosemide (Lasix)
• D. Intravenous immune globulin (IVIG)

Correct answer: B

Rationale: Children with spina bifida, especially those with a neurogenic bladder, are at an increased risk of urinary tract infections. Sulfisoxazole, an antibiotic, is commonly prescribed prophylactically to prevent UTIs in this population. Prednisone (Choice A) is a corticosteroid and is not typically used for prophylaxis in this scenario. Furosemide (Lasix) (Choice C) is a diuretic used to treat fluid retention and hypertension, not for preventing UTIs. Intravenous immune globulin (IVIG) (Choice D) is used to boost the immune system, not for UTI prophylaxis in this case.

5. 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.

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