Nursing Elites

1. A client with heart failure is prescribed furosemide (Lasix) and digoxin (Lanoxin). Which instruction should the nurse include in the client's teaching plan?

• A. Avoid foods high in potassium.
• B. Report a pulse rate less than 60 beats per minute.
• C. Take the medications in the morning.
• D. Weigh yourself daily.

Correct answer: B

Rationale: The correct answer is B. The nurse should instruct the client to report a pulse rate less than 60 beats per minute, as it could indicate digoxin toxicity. Consuming potassium-rich foods is encouraged due to the potential for furosemide (Lasix) to cause hypokalemia. The medications should be taken in the morning to prevent nocturia. Weighing oneself daily is important to monitor for fluid retention, a crucial aspect in managing heart failure. Therefore, choices A, C, and D are incorrect as they do not address the specific teaching point related to digoxin and its potential toxicity.

2. A child is hospitalized with a diagnosis of lead poisoning. The healthcare provider assisting in caring for the child would prepare to assist in administering which of the following medications?

• A. Activated charcoal
• B. Sodium bicarbonate
• C. Syrup of ipecac
• D. Dimercaprol (BAL in Oil)

Correct answer: D

Rationale: Dimercaprol (BAL in Oil) is a chelating agent indicated for lead poisoning. It works by binding to lead and facilitating its removal from the body. Activated charcoal is used for certain types of poisoning by adsorbing toxins, while sodium bicarbonate can be used to treat acidosis. Syrup of ipecac is no longer recommended for poison treatment due to potential risks.

3. A client is prescribed nitroglycerin (Nitro-Dur) transdermal patch for angina. Which instruction should the nurse include in the client's teaching plan?

• A. Apply the patch to a hairless area of skin.
• B. Leave the patch on for 24 hours.
• C. Apply the patch at the same time each day.
• D. You can keep the patch on while taking a shower.

Correct answer: C

Rationale: The correct instruction for the nurse to include in the client's teaching plan is to apply the nitroglycerin (Nitro-Dur) transdermal patch at the same time each day. This consistency helps maintain steady blood levels of the medication. While it is important to apply the patch to a hairless area of the skin for proper absorption, it does not necessarily have to be left on for 24 hours; typically, it is worn for 12-14 hours to allow for a nitrate-free period and reduce tolerance. Additionally, the patch can generally be kept on while taking a shower, as water exposure does not typically affect its efficacy.

4. The client has reinforced instructions for taking cholestyramine (Questran). Which statement indicates a need for further instructions?

• A. I will continue taking vitamin supplements.
• B. This medication will help lower my cholesterol.
• C. This medication should only be taken with water.
• D. A high-fiber diet is important while taking this medication.

Correct answer: C

Rationale: The correct answer is C because cholestyramine should not only be taken with water. Flavored products or fruit juices can improve the taste. Choices A, B, and D are all correct statements. It is important for the client to continue taking vitamin supplements, understand that cholestyramine helps lower cholesterol, and maintain a high-fiber diet while taking this medication to enhance its effectiveness.

5. A client is being taught about the use of enoxaparin (Lovenox) for the prevention of deep vein thrombosis. Which instruction should the nurse include in the teaching plan?

• A. Inject the medication subcutaneously.
• B. Avoid massaging the injection site after administration.
• C. Administer the medication at the same time each day.
• D. Do not expel the air bubble from the syringe before injection.

Correct answer: C

Rationale: Enoxaparin (Lovenox) is administered subcutaneously at the same time each day to maintain consistent blood levels. Injecting the medication into the muscle is incorrect, as it should be given subcutaneously. Massaging the injection site should be avoided to prevent bruising. The air bubble in the prefilled syringe should not be expelled, as it ensures the full dose is administered.

Similar Questions