Nursing Elites

1. A patient is receiving IV heparin for a deep-vein thrombosis and begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer?

• A. Vitamin K1
• B. Atropine
• C. Protamine
• D. Calcium gluconate

Correct answer: C

Rationale: Protamine is the antidote for heparin, as it reverses its anticoagulant effects. In cases of heparin overdose or if there is excessive bleeding, administering protamine can quickly neutralize the effects of heparin, helping to prevent further bleeding complications.

2. A healthcare professional is preparing to administer an IV bolus of Morphine to a client for pain management. Which of the following assessments is the healthcare professional's priority?

• A. Respiratory rate
• B. Pain level
• C. Blood pressure
• D. Level of consciousness

Correct answer: A

Rationale: The priority assessment for a client receiving an IV bolus of Morphine is the respiratory rate. Morphine can cause respiratory depression, which is a serious adverse effect. Monitoring the respiratory rate is crucial to detect any signs of respiratory compromise early and intervene promptly. Assessing pain level, blood pressure, and level of consciousness are also important but not the priority in this situation. Pain level can be assessed after ensuring the client's respiratory status is stable. Blood pressure and level of consciousness should be monitored but do not take precedence over the respiratory rate when administering Morphine.

3. A client has a new prescription for Captopril for hypertension. The nurse should monitor the client for which of the following adverse effects of this medication?

• A. Hypokalemia
• B. Hypernatremia
• C. Neutropenia
• D. Bradycardia

Correct answer: C

Rationale: Neutropenia is a serious adverse effect associated with ACE inhibitors like Captopril. It is characterized by a decreased level of neutrophils, which are important in fighting infections. Monitoring the client's complete blood count (CBC) is crucial to detect neutropenia early. The nurse should also educate the client on recognizing signs of infection and promptly reporting them to the healthcare provider for timely intervention. Hypokalemia is a potential adverse effect of diuretics, not ACE inhibitors. Hypernatremia is an electrolyte imbalance more commonly associated with conditions like dehydration. Bradycardia is not a typical adverse effect of Captopril.

4. A client has a new prescription for a Fentanyl transdermal patch. Which of the following instructions should the nurse include?

• A. Apply the patch to a non-hairy area.
• B. Change the patch every 72 hours.
• C. Avoid exposure to heat sources.
• D. Do not cut the patch to adjust the dosage.

Correct answer: C

Rationale: The correct instruction the nurse should include for a client using a Fentanyl transdermal patch is to avoid exposure to heat sources. Heat can increase the absorption of the medication, potentially causing an overdose. Instructing the client to avoid heat sources is crucial to ensure their safety and the effectiveness of the medication. Choices A, B, and D are incorrect because applying the patch to a non-hairy area, changing it every 72 hours, and not cutting the patch are general guidelines for using transdermal patches but do not specifically address the unique risks associated with Fentanyl patches.

5. A client has a new prescription for Fluoxetine for PTS. Which of the following statements should the nurse include in the teaching?

• A. You may have a decreased desire for intimacy while taking this medication.
• B. You should take this medication at bedtime to help promote sleep.
• C. You will have fewer urinary adverse effects if you urinate just before taking this medication.
• D. You'll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication.

Correct answer: A

Rationale: The correct statement for the nurse to include in the teaching is 'You may have a decreased desire for intimacy while taking this medication.' One of the potential adverse effects of fluoxetine and other SSRIs is a decreased desire for intimacy. It is essential for the nurse to educate the client about this possible side effect to enhance understanding and promote informed decision-making. Choices B, C, and D are incorrect because they do not relate to common side effects of Fluoxetine that the nurse should include in the teaching.

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