Nursing Elites

1. A client has a new prescription for hydrochlorothiazide to treat hypertension. Which of the following instructions should be included?

• A. Take the medication in the morning.
• B. Increase intake of potassium-rich foods.
• C. Avoid sun exposure while taking this medication.
• D. Limit fluid intake to 1 liter per day.

Correct answer: B

Rationale: The correct instruction that should be included for a client prescribed hydrochlorothiazide is to increase the intake of potassium-rich foods. Hydrochlorothiazide, being a diuretic, can lead to hypokalemia by enhancing potassium excretion. Increasing consumption of potassium-rich foods like bananas or oranges can help prevent hypokalemia and maintain electrolyte balance. Choices A, C, and D are incorrect. Taking the medication in the morning is not a specific instruction related to hydrochlorothiazide. Avoiding sun exposure is more relevant for photosensitive medications, not hydrochlorothiazide. Limiting fluid intake to 1 liter per day is not necessary unless specifically advised by a healthcare provider.

2. A patient is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

• A. Hemoglobin
• B. Prothrombin time (PT)
• C. Bleeding time
• D. Activated partial thromboplastin time (aPTT)

Correct answer: B

Rationale: The correct answer is to monitor Prothrombin time (PT) when a patient is on warfarin therapy. Warfarin affects blood clotting, and PT is used to assess the therapeutic effect of this medication. Hemoglobin (Choice A) is not directly affected by warfarin therapy and does not reflect its therapeutic effect. Bleeding time (Choice C) measures the time it takes for bleeding to stop after a standardized cut and is not specific to warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice D) is more commonly used to monitor heparin therapy, not warfarin.

3. When using Nitroglycerine (transdermal), how many hours should you be nitrate-free each day?

• A. 1-2 hours
• B. 5-10 hours
• C. 3-4 hours
• D. 10-12 hours

Correct answer: D

Rationale: When using Nitroglycerine (transdermal), it should be applied for 10-12 hours per day to ensure its effectiveness. A nitrate-free period within the day is essential to prevent the development of tolerance to the medication.

4. A client with Bipolar disorder has a new prescription for Carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

• A. This medication can safely be taken during pregnancy.
• B. Eliminate grapefruit juice from your diet.
• C. You will need to have a complete blood count and carbamazepine levels drawn periodically.
• D. Notify your provider if you develop a rash.

Correct answer: B

Rationale: The correct answer is B: "Eliminate grapefruit juice from your diet." Grapefruit juice affects carbamazepine metabolism and should be avoided. It can lead to increased levels of the medication, potentially causing toxicity. Monitoring carbamazepine blood levels and the complete blood count (CBC) is essential to ensure the medication's efficacy and safety. Although choice A is incorrect (This medication can safely be taken during pregnancy), carbamazepine is classified as a Pregnancy Category D drug, which means there is positive evidence of human fetal risk. Choice D (Notify your provider if you develop a rash) is also important because carbamazepine can cause serious adverse effects like Stevens-Johnson syndrome, which can be life-threatening. Regular monitoring and prompt reporting of any rash are crucial. Therefore, choices C and D are also relevant instructions for the client.

5. What instruction should the healthcare provider include to minimize an adverse effect of Clomipramine for OCD in an adolescent client?

• A. Wear sunglasses when outdoors.
• B. Check your temperature daily.
• C. Take this medication in the morning.
• D. Add extra calories to your diet.

Correct answer: A

Rationale: The correct answer is A: 'Wear sunglasses when outdoors.' To minimize the anticholinergic effect of Clomipramine, the client should wear sunglasses when outdoors to reduce photophobia. This adverse effect is common with tricyclic antidepressant (TCA) use. Choices B, C, and D are incorrect. Checking temperature daily, timing of medication intake, or adding extra calories to the diet are not directly related to minimizing adverse effects of Clomipramine.

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