Nursing Elites

1. A nurse is providing discharge teaching to a client who has a new prescription for Warfarin. Which of the following statements should the nurse include?

• A. You should avoid taking aspirin for headaches while on this medication.
• B. You should use a soft toothbrush to brush your teeth.
• C. You should avoid foods that are rich in vitamin K.
• D. You should avoid prolonged exposure to sunlight.

Correct answer: B

Rationale: The correct statement to include in discharge teaching for a client prescribed Warfarin is to use a soft toothbrush to prevent gum bleeding. Warfarin is an anticoagulant that increases the risk of bleeding, so using a soft toothbrush can help prevent gum injury and bleeding. Choice A is incorrect because aspirin, another blood-thinning medication, should generally be avoided while on Warfarin to reduce the risk of bleeding. Choice C is incorrect because clients on Warfarin should maintain a consistent intake of vitamin K-rich foods rather than avoid them completely. Choice D is unrelated to the medication and not a priority teaching point for a client prescribed Warfarin.

2. A client prescribed Warfarin is receiving discharge instructions from a nurse. Which of the following herbal supplements should the nurse instruct the client to avoid?

• A. St. John's wort
• B. Echinacea
• C. Garlic
• D. Ginseng

Correct answer: A

Rationale: St. John's wort can reduce the effectiveness of Warfarin by interacting with its metabolism pathways, potentially leading to decreased anticoagulant effects. Therefore, clients on Warfarin therapy should avoid St. John's wort. While echinacea, garlic, and ginseng are also herbal supplements that can interact with Warfarin, St. John's wort is particularly known for its significant impact on Warfarin metabolism. Echinacea may increase the risk of bleeding when taken with Warfarin, garlic may potentiate the anticoagulant effects of Warfarin, and ginseng may also increase the risk of bleeding. However, St. John's wort is the most crucial to avoid due to its significant impact on Warfarin metabolism.

3. A client with early Parkinson's disease has been prescribed pramipexole. What adverse effect should the nurse instruct the client to monitor for?

• A. Hallucinations
• B. Increased salivation
• C. Diarrhea
• D. Discoloration of urine

Correct answer: A

Rationale: The correct answer is A: Hallucinations. Pramipexole can lead to hallucinations within 9 months of the initial dose, which may necessitate discontinuation of the medication. Monitoring for hallucinations is crucial to ensure early detection and management to prevent any adverse outcomes. Choice B, increased salivation, is not a common adverse effect of pramipexole. Choice C, diarrhea, is not typically associated with pramipexole use. Choice D, discoloration of urine, is not a known adverse effect of pramipexole and is not typically a concern with this medication.

4. A client with angina is being taught how to use nitroglycerin transdermal ointment. Which instruction should the nurse include?

• A. Remove the prior dose before applying a new dose.
• B. Rub the ointment directly into the skin until it is no longer visible.
• C. Cover the applied ointment with a clean gauze pad.
• D. Apply the ointment to the same skin area each time.

Correct answer: A

Rationale: The correct instruction is to remove the prior dose before applying a new one to prevent toxicity. Nitroglycerin ointment can cause adverse effects if accumulated doses are not removed. Rubbing the ointment until it's not visible or covering it with gauze may alter absorption. Applying it to the same area each time can lead to skin irritation or desensitization.

5. Which of the following conditions is not treated with epinephrine?

• A. Renal disease
• B. Asthma
• C. Hypotension
• D. Glaucoma

Correct answer: A

Rationale: Epinephrine is not used to treat renal disease. Epinephrine is commonly used to treat conditions like asthma, hypotension, and glaucoma, but it is not an appropriate treatment for renal disease. Renal disease requires specific management strategies that do not involve the use of epinephrine.

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