Nursing Elites

1. When teaching a client with a prescription for Phenytoin, which of the following instructions should the nurse include?

• A. Expect the development of a mild rash.
• B. Take the medication on an empty stomach.
• C. Monitor for signs of gingival hyperplasia.
• D. Increase your intake of calcium.

Correct answer: C

Rationale: Phenytoin is known to cause gingival hyperplasia, a condition characterized by overgrowth of gum tissue. The nurse should instruct the client to monitor for signs of gingival hyperplasia, such as swollen or bleeding gums. Good oral hygiene practices are essential to prevent or manage this side effect. Choices A, B, and D are incorrect. Phenytoin does not typically cause a mild rash, should be taken with food to reduce gastrointestinal upset, and does not warrant an increase in calcium intake.

2. A healthcare provider is caring for several clients who came to the clinic for a seasonal influenza immunization. The healthcare provider should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection?

• A. 1-year-old with no health problems
• B. 17-year-old with a hypersensitivity to Penicillin
• C. 25-year-old who is pregnant
• D. 52-year-old who takes a multivitamin supplement

Correct answer: B

Rationale: A 17-year-old can be immunized for influenza with the LAIV via nasal spray. A hypersensitivity to penicillin is not a contraindication for an influenza immunization. Nasal spray influenza vaccine is generally recommended for healthy individuals between 2 and 49 years old. Choices A, C, and D are not candidates for nasal spray influenza vaccine. A 1-year-old is too young, pregnant individuals should not receive the nasal spray, and age is a factor for the use of the nasal spray vaccine.

3. A client has ordered a thrombolytic medication for the treatment of CVA. Which type of stroke should not be treated with a thrombolytic?

• A. Hemorrhagic stroke
• B. Thrombotic stroke
• C. Both types can be treated with a thrombolytic
• D. Neither type can be treated with a thrombolytic

Correct answer: A

Rationale: Thrombolytic medications are used to dissolve blood clots. In the case of a hemorrhagic stroke, where there is bleeding in the brain, the use of thrombolytics can worsen the condition by increasing bleeding. Therefore, hemorrhagic strokes should not be treated with thrombolytic medications.

4. A client has a new prescription for Warfarin for atrial fibrillation. Which of the following findings should the nurse report to the provider immediately?

• A. INR of 4.0
• B. Potassium level of 4.5 mEq/L
• C. Sodium level of 140 mEq/L
• D. Creatinine level of 1.0 mg/dL

Correct answer: A

Rationale: An INR of 4.0 is above the therapeutic range for a client on Warfarin, indicating an increased risk of bleeding. This finding requires immediate reporting to the provider for appropriate intervention to prevent complications associated with excessive anticoagulation. Potassium, sodium, and creatinine levels are within normal ranges and are not directly related to the risk of bleeding in a client on Warfarin therapy.

5. A client with Depression has a new prescription for Venlafaxine. For which of the following adverse effects should the nurse monitor this client? (Select all that apply)

• A. Cough
• B. Dizziness
• C. Decreased libido
• D. B and C

Correct answer: D

Rationale: The correct answer is D: 'B and C.' Venlafaxine, a medication used to treat depression, can lead to adverse effects like dizziness and decreased libido. It is important for the nurse to monitor the client for these potential side effects. Cough and alopecia are not typically associated with Venlafaxine. Therefore, choices A (Cough) and C (Decreased libido) are incorrect. Dizziness and decreased libido are the adverse effects that the nurse should focus on when monitoring a client on Venlafaxine treatment.

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