Nursing Elites

1. A client is to receive Tetracaine before a Bronchoscopy. Which of the following actions should the nurse include in the plan of care?

• A. Keep the client NPO until the pharyngeal response returns.
• B. Monitor the insertion site for a hematoma.
• C. Palpate the bladder to detect urinary retention.
• D. Maintain the client on bed rest for 12 hours following the procedure.

Correct answer: A

Rationale: The correct action for the nurse to include in the plan of care is to keep the client NPO until the pharyngeal response returns. Tetracaine can affect the gag reflex, so it is important to prevent aspiration by maintaining the client NPO until the pharyngeal response is normal, which typically takes about 1 hour. Monitoring for the return of the gag reflex is crucial to prevent complications from aspiration during the first oral intake after the procedure. Choices B, C, and D are incorrect because they are not directly related to the effects of Tetracaine or the bronchoscopy procedure.

2. When teaching a client with a new prescription for Ipratropium, which of the following instructions should the nurse include?

• A. This medication can be used as a rescue inhaler.
• B. This medication should be taken before albuterol.
• C. Wait 5 minutes between medications if two inhaled medications are prescribed.
• D. Ipratropium can be used before exercise.

Correct answer: C

Rationale: When two inhaled medications are prescribed, waiting 5 minutes between medications allows for optimal absorption and effectiveness of each medication. This ensures that each medication can work properly without interference from the other, improving the client's respiratory condition.

3. An older adult client has a new prescription for Digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for Digoxin toxicity?

• A. Phenytoin
• B. Verapamil
• C. Warfarin
• D. Aluminum hydroxide

Correct answer: B

Rationale: Verapamil, a calcium-channel blocker, can increase digoxin levels, leading to toxicity. When given together, the digoxin dosage may need adjustment, and the nurse should closely monitor the client's digoxin levels to prevent toxicity symptoms such as nausea, vomiting, visual disturbances, and arrhythmias. The other choices, Phenytoin, Warfarin, and Aluminum hydroxide, do not significantly interact with Digoxin to cause toxicity. Phenytoin may reduce Digoxin levels, while Warfarin and Aluminum hydroxide have minimal interactions with Digoxin.

4. A nurse is providing teaching to a client who has asthma and is beginning to take montelukast. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will use this medication as a rescue inhaler during asthma attacks.
• B. I should take this medication once daily in the evening.
• C. I need to have my blood levels checked regularly while taking this medication.
• D. I should take this medication before exercising to prevent bronchospasm.

Correct answer: B

Rationale: Montelukast is typically taken once daily in the evening for long-term control of asthma symptoms. It helps prevent asthma attacks by reducing inflammation in the airways. While montelukast can also be used for exercise-induced bronchospasm in some cases, it is generally not a rescue medication and should be taken regularly, not on an as-needed basis.

5. A client is starting a new prescription for ferrous sulfate. Which of the following instructions should the nurse include?

• A. Take the medication with meals.
• B. Take the medication on an empty stomach.
• C. Take the medication with orange juice to enhance absorption.
• D. Take the medication with a full glass of milk.

Correct answer: C

Rationale: The correct answer is C: 'Take the medication with orange juice to enhance absorption.' Taking ferrous sulfate with orange juice helps enhance the absorption of iron due to the ascorbic acid present in the orange juice, which aids in iron absorption. This combination can help improve the effectiveness of the medication. Choice A, taking the medication with meals, may reduce gastrointestinal side effects but does not specifically enhance absorption. Choice B, taking the medication on an empty stomach, may lead to better absorption but can also increase the risk of gastrointestinal side effects. Choice D, taking the medication with a full glass of milk, is incorrect because calcium in milk can inhibit the absorption of iron.

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