Nursing Elites

1. A client has a new diagnosis of Fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client?

• A. Colchicine
• B. Hydroxychloroquine
• C. Auranofin
• D. Duloxetine

Correct answer: D

Rationale: The correct answer is D, Duloxetine. Duloxetine is a serotonin-norepinephrine reuptake inhibitor commonly used to manage fibromyalgia. It helps in reducing pain and improving mood in individuals with this condition. Colchicine (Choice A) is primarily used to treat gout, while Hydroxychloroquine (Choice B) and Auranofin (Choice C) are medications used to manage conditions like rheumatoid arthritis and lupus, not fibromyalgia.

2. 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.

3. 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.

4. What is a desired outcome of the drug Phenytoin?

• A. Decrease symptoms of PTSD
• B. Resolution of signs of infection
• C. Decrease or cessation of seizures without excessive sedation
• D. Prevention or relief of bronchospasm

Correct answer: C

Rationale: The correct answer is C: Decrease or cessation of seizures without excessive sedation. Phenytoin is primarily used as an antiepileptic medication to manage and prevent seizures. It does not directly impact symptoms of PTSD (Choice A), resolution of signs of infection (Choice B), or prevention or relief of bronchospasm (Choice D). Therefore, the desired outcome of Phenytoin is to control seizures effectively while avoiding excessive sedation.

5. A client with Atrial Fibrillation is prescribed Dabigatran to prevent Thrombosis. Which medication is prescribed concurrently to treat an adverse effect of Dabigatran?

• A. Vitamin K1
• B. Protamine
• C. Omeprazole
• D. Probenecid

Correct answer: C

Rationale: Omeprazole or another proton pump inhibitor is commonly prescribed for clients taking dabigatran who experience abdominal pain and other gastrointestinal adverse effects associated with dabigatran use. Proton pump inhibitors help alleviate these symptoms by reducing gastric acid secretion, which can contribute to gastrointestinal discomfort. Vitamin K1 is not indicated for adverse effects of dabigatran. Protamine is used to reverse the anticoagulant effects of heparin, not dabigatran. Probenecid is not typically used to treat adverse effects of dabigatran.

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