Nursing Elites

1. A client is prescribed Nitroglycerin sublingual tablets. Which of the following instructions should the nurse include during discharge teaching?

• A. Take the medication with food.
• B. Store the medication in a cool, dry place.
• C. Swallow the tablets whole.
• D. Take one tablet every 5 minutes up to three doses for chest pain.

Correct answer: D

Rationale: During a chest pain episode, the client should take one nitroglycerin tablet sublingually every 5 minutes up to a total of three doses. If chest pain persists after three doses, emergency medical attention should be sought. Nitroglycerin should not be swallowed but allowed to dissolve under the tongue for rapid absorption. Storing the medication in a cool, dry place helps maintain its effectiveness.

2. A client has a new prescription for Adalimumab for Rheumatoid Arthritis. Based on the route of administration of Adalimumab, which of the following should the nurse plan to monitor?

• A. The vein for thrombophlebitis during IV administration.
• B. The subcutaneous site for redness following injection.
• C. The oral mucosa for ulceration after oral administration.
• D. The skin for irritation following removal of transdermal patch.

Correct answer: B

Rationale: Adalimumab is administered subcutaneously for Rheumatoid Arthritis. Injection-site reactions such as redness and swelling are common. Therefore, the nurse should monitor the subcutaneous site for redness following the injection to assess for potential adverse effects.

3. A client with thrombophlebitis receiving heparin by continuous IV infusion asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

• A. It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.
• B. A pharmacist is the person to answer that question.
• C. Heparin does not dissolve clots. It stops new clots from forming.
• D. The oral medication you will take after this IV will dissolve the clot.

Correct answer: C

Rationale: The correct response is C. Heparin does not dissolve clots; it prevents new clots from forming. Heparin works by inhibiting the formation of new clots and the extension of existing clots, rather than directly dissolving them. The client should be informed that the purpose of heparin therapy is to prevent the clot from getting larger and to reduce the risk of new clots forming. Choices A, B, and D are incorrect. Choice A talks about reaching a therapeutic blood level of heparin, which is not related to clot dissolution. Choice B deflects the question to a pharmacist without providing relevant information. Choice D inaccurately suggests that an oral medication will dissolve the clot, which is not the mechanism of action for heparin.

4. When providing discharge instructions to a client with a new prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Avoid salt substitutes.
• B. Take this medication at bedtime.
• C. Increase your intake of potassium-rich foods.
• D. Take this medication with food.

Correct answer: A

Rationale: The correct answer is to instruct the client to avoid salt substitutes. Lisinopril, an ACE inhibitor, can lead to hyperkalemia, so it is essential to avoid salt substitutes containing potassium, which can further increase potassium levels in the body. This instruction aims to prevent potential adverse effects and ensure the client's safety while taking Lisinopril. Choices B, C, and D are incorrect because Lisinopril is typically taken once a day in the morning, it can lead to hyperkalemia (so increasing potassium-rich foods is not advised), and it can be taken with or without food.

5. A client has a new prescription for Filgrastim. Which of the following instructions should be included by the healthcare provider?

• A. Take this medication with food.
• B. Avoid taking this medication with orange juice.
• C. Report bone pain to your healthcare provider.
• D. Expect a persistent cough while taking this medication.

Correct answer: C

Rationale: The correct answer is C: 'Report bone pain to your healthcare provider.' Filgrastim is known to cause bone pain as a common side effect. Therefore, it is crucial for clients to report any bone pain to their healthcare provider to monitor for potential complications or the need for further management. Choices A, B, and D are incorrect because taking Filgrastim with food, avoiding it with orange juice, and expecting a persistent cough are not relevant instructions associated with this medication.

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