Nursing Elites

1. A client prescribed Warfarin is receiving discharge instructions from a nurse. Which of the following dietary instructions should the nurse include?

• A. Increase your intake of leafy green vegetables.
• B. Avoid foods high in vitamin K.
• C. Increase your intake of dairy products.
• D. Avoid foods high in iron.

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Vitamin K can interfere with the effectiveness of Warfarin, an anticoagulant medication. Foods high in vitamin K, such as leafy green vegetables, can reduce the medication's anticoagulant effect. Therefore, clients taking Warfarin should be advised to avoid or consume a consistent amount of foods high in vitamin K to maintain the medication's effectiveness. Choices A, C, and D are incorrect because increasing leafy green vegetables, dairy products, or avoiding foods high in iron are not directly related to the interaction with Warfarin.

2. When discussing immunizations, which vaccine series is typically completed before a child's first birthday?

• A. Pneumococcal conjugate vaccine
• B. Meningococcal conjugate vaccine
• C. Varicella vaccine
• D. Rotavirus vaccine

Correct answer: D

Rationale: The correct answer is D, Rotavirus vaccine. The rotavirus vaccine series is usually completed before a child's first birthday. It is given to infants in a series of doses starting at 2 months of age and must be completed by 8 months of age. This vaccine helps protect against severe diarrhea and vomiting caused by rotavirus infection, which is common in infants and young children. Choices A, B, and C are incorrect because the Pneumococcal conjugate vaccine, Meningococcal conjugate vaccine, and Varicella vaccine are not typically completed before a child's first birthday.

3. A client is taking Paroxetine to treat PTSD and reports teeth grinding at night. Which interventions should the nurse implement to manage Bruxism? (Select all that apply.)

• A. Concurrent administration of buspirone.
• B. Administration of a different SSRI.
• C. Use of a mouth guard.
• D. Changing to a different class of antidepressant medication.

Correct answer: A

Rationale: The correct interventions to manage Bruxism associated with Paroxetine use include A: Concurrent administration of buspirone. Buspirone can help alleviate the side effect of Bruxism. Additionally, C: Use of a mouth guard is recommended to prevent oral damage from teeth grinding. B: Administration of a different SSRI is not necessary since the issue is specific to Paroxetine. D: Changing to a different class of antidepressant medication may be considered in severe cases, but the initial step should be to add buspirone to address the Bruxism caused by Paroxetine.

4. A healthcare professional is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the healthcare professional adjust the manual IV infusion to deliver?

• A. 22 gtt/min
• B. 24 gtt/min
• C. 20 gtt/min
• D. 18 gtt/min

Correct answer: A

Rationale: To calculate the flow rate, use the formula: (Volume in mL x Drop factor) / Time in minutes = Flow rate in gtt/min. In this case, (100 mL x 10 gtt/mL) / 45 min = 22 gtt/min. Thus, the healthcare professional should adjust the manual IV infusion to deliver 22 gtt/min. Choice B, 24 gtt/min, is incorrect because it miscalculates the flow rate. Choices C and D, 20 gtt/min and 18 gtt/min, are also incorrect as they do not accurately calculate the flow rate based on the given information.

5. A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

• A. Document that the client experienced an anaphylactic reaction to the medication.
• B. Change the IV infusion site.
• C. Decrease the infusion rate on the IV.
• D. Apply cold compresses to the neck area.

Correct answer: C

Rationale: Flushing and tachycardia are signs of Red Man Syndrome, which can be mitigated by decreasing the infusion rate.

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