Nursing Elites

1. A client with active tuberculosis asks why he must take four different medications. Which of the following responses should the nurse make?

• A. Taking four medications decreases the risk of a severe allergic reaction.
• B. Taking four medications reduces the chance that the bacteria will become resistant.
• C. Taking four medications reduces the risk of adverse reactions.
• D. Taking four medications decreases the chance of having a positive tuberculin skin test.

Correct answer: B

Rationale: When treating tuberculosis, using a combination of multiple medications is crucial to reduce the risk of bacterial resistance. The use of four medications helps to target the bacteria from different angles, making it harder for them to develop resistance to the treatment. This approach is essential to ensure the effectiveness of the treatment regimen and to prevent the spread of drug-resistant strains of tuberculosis. Choices A, C, and D are incorrect because the primary reason for using multiple medications in tuberculosis treatment is to prevent the development of bacterial resistance, not to decrease the risk of allergic reactions, adverse reactions, or affecting the tuberculin skin test results.

2. When caring for a client prescribed warfarin, which laboratory test should the nurse monitor to evaluate the therapeutic effect of the medication?

• A. aPTT
• B. Platelet count
• C. BUN
• D. PT/INR

Correct answer: D

Rationale: The correct laboratory test to monitor the therapeutic effect of warfarin is the PT/INR. Warfarin affects blood clotting, and the PT/INR levels indicate the effectiveness of the medication in preventing clot formation. Therefore, monitoring PT/INR levels helps ensure that the client is within the therapeutic range and is protected from potential complications related to clotting. Choice A (aPTT) is incorrect because while it measures the clotting time, it is not the preferred test for monitoring warfarin therapy. Choice B (Platelet count) is incorrect as it assesses the number of platelets and not the medication's therapeutic effect. Choice C (BUN) is unrelated to monitoring the effects of warfarin therapy and is primarily used to assess kidney function.

3. A client has a new prescription for Clonidine. Which of the following instructions should the nurse include?

• A. Expect to feel drowsy.
• B. Increase your intake of high-potassium foods.
• C. Take the medication with grapefruit juice.
• D. Avoid foods high in fat.

Correct answer: A

Rationale: The correct answer is to expect to feel drowsy. Clonidine is known to cause drowsiness, especially at the beginning of treatment. It is important for clients to be cautious with activities that require alertness until they understand how the medication affects them. Choice B is incorrect as there is no specific need to increase high-potassium foods with Clonidine. Choice C is incorrect as grapefruit juice can interact with many medications but is not a typical instruction for Clonidine. Choice D is incorrect as there is no specific indication to avoid foods high in fat with Clonidine.

4. When educating a client who has a prescription for Propranolol, what instruction should the healthcare provider include?

• A. Take this medication with food.
• B. Discontinue the medication if you feel fatigued.
• C. Expect to have decreased heart rate with this medication.
• D. Do not stop taking this medication abruptly.

Correct answer: D

Rationale: The correct instruction for a client with a prescription for Propranolol is not to stop taking the medication abruptly. Abrupt cessation can result in rebound hypertension or other cardiac complications. It is crucial for the client to taper off the medication gradually under healthcare provider supervision to prevent adverse effects. Choice A is incorrect because Propranolol can be taken with or without food. Choice B is incorrect as discontinuing the medication based on fatigue alone is not advisable without consulting a healthcare provider. Choice C is incorrect because while Propranolol can decrease heart rate, it is not the primary instruction to provide in this scenario.

5. A client has a new prescription for a Nitroglycerin transdermal patch for Angina Pectoris. Which of the following instructions should the nurse include?

• A. Remove the patch each evening.
• B. Do not cut the patch in half even if angina attacks are under control.
• C. Take off the nitroglycerin patch if a headache occurs.
• D. Apply a new patch every 48 hours.

Correct answer: A

Rationale: The correct instruction is to remove the nitroglycerin patch each evening to prevent tolerance. This allows for a 10- to 12-hour nitrate-free period daily, reducing the risk of developing tolerance to nitroglycerin. Cutting the patch in half is not recommended because it can alter the dosing and absorption rate, leading to inadequate symptom control. Taking off the patch for a headache is not necessary as headaches are a common side effect that may improve with continued use. Applying a new patch every 48 hours is not correct as it may not provide continuous symptom relief for angina.

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