Nursing Elites

1. A client has a new prescription for nitroglycerin transdermal patches. Which of the following instructions should the nurse include?

• A. Apply the patch to a different location each day.
• B. Remove the patch every night before bedtime.
• C. Massage the patch area gently after application.
• D. Shave the area before applying the patch.

Correct answer: B

Rationale: The correct instruction for a client using nitroglycerin transdermal patches is to remove the patch every night before bedtime. This practice helps prevent tolerance to the medication's effects. Continuous exposure to nitroglycerin can result in the body becoming less responsive to its therapeutic effects over time, reducing its efficacy in managing the prescribed condition. Choices A, C, and D are incorrect. Applying the patch to a different location each day does not address the issue of tolerance. Massaging the patch area gently after application is not recommended as it may alter drug absorption. Shaving the area before applying the patch is unnecessary and may increase the risk of skin irritation.

2. Which of the following is commonly used to treat migraine headaches?

• A. Beta-blockers
• B. Cholinesterase Inhibitors
• C. ACE inhibitors
• D. Anti-epileptic drugs (AEDs)

Correct answer: D

Rationale: Anti-epileptic drugs (AEDs) are often used in the management of migraine headaches due to their ability to help prevent or reduce the frequency and intensity of migraines. They work by stabilizing electrical activity in the brain, which can help in controlling migraine symptoms. While beta-blockers are also sometimes used in migraine prevention, anti-epileptic drugs are more commonly associated with migraine treatment. Cholinesterase Inhibitors are not typically used for migraine headaches, as they are more commonly associated with conditions like Alzheimer's disease. ACE inhibitors are a type of medication used to treat conditions like high blood pressure and heart failure, but they are not a first-line treatment for migraines.

3. What is the therapeutic use of Phenytoin?

• A. Replacement in hypothyroidism to restore normal hormonal balance
• B. Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux
• C. Diminished seizure activity, termination of ventricular arrhythmias
• D. Prevention of thrombus formation, prevention of extension of existing thrombi

Correct answer: C

Rationale: Phenytoin is primarily used to diminish seizure activity and is effective in terminating ventricular arrhythmias. It works by stabilizing neuronal membranes, reducing repetitive neuronal firing, and limiting the spread of seizure activity in the brain. While phenytoin does not have a direct role in preventing thrombus formation or extending existing thrombi, it is crucial in managing seizures and certain arrhythmias.

4. A healthcare provider is reviewing the health care record of a client who reports urinary incontinence and asks about a prescription for Oxybutynin. The provider should recognize that Oxybutynin is contraindicated in the presence of which of the following conditions?

• A. Bursitis
• B. Sinusitis
• C. Depression
• D. Glaucoma

Correct answer: D

Rationale: Oxybutynin is an anticholinergic medication that can increase intraocular pressure. It is contraindicated in clients with glaucoma, as it can worsen the condition. Glaucoma is a condition characterized by increased intraocular pressure, and using Oxybutynin can further elevate this pressure, potentially leading to serious complications such as vision impairment or damage to the optic nerve. Choices A, B, and C are incorrect as bursitis, sinusitis, and depression are not contraindications for Oxybutynin use. Therefore, the correct answer is D, Glaucoma.

5. A client is receiving discharge instructions for long-term use of Prednisone. Which of the following instructions should be included?

• A. Stop taking the medication if you experience swelling.
• B. The provider will monitor your weight regularly.
• C. Take the medication on an empty stomach.
• D. You may notice decreased appetite while on this medication.

Correct answer: B

Rationale: The correct answer is B because long-term use of Prednisone can lead to weight gain, necessitating regular weight monitoring by the healthcare provider to manage any potential complications. Prednisone often causes fluid retention, leading to weight gain, hence the need for weight monitoring. Options A, C, and D are incorrect because swelling is not a typical reason to stop Prednisone, taking it on an empty stomach is not usually required, and Prednisone commonly increases appetite rather than decreases it.

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