Nursing Elites

1. A client is to receive Pamidronate for bone pain related to cancer. What precaution should the nurse take during the administration of Pamidronate?

• A. Inspect the skin for redness and irritation around the injection site.
• B. Assess the IV site for thrombophlebitis frequently during administration.
• C. Instruct the client to lie down for 30 minutes after oral administration.
• D. Monitor for signs of anaphylaxis for 20 minutes after intramuscular injection.

Correct answer: B

Rationale: Pamidronate is typically administered through IV infusion, which can cause irritation to veins. The nurse should frequently assess the IV site for thrombophlebitis during the administration to promptly detect any potential complications related to the infusion. Inspecting the skin for redness and irritation around the injection site (Choice A) is not directly related to IV infusion. Instructing the client to lie down after oral administration (Choice C) is not necessary for IV administration. Monitoring for signs of anaphylaxis after an intramuscular injection (Choice D) is not relevant for an IV infusion of Pamidronate.

2. A healthcare professional is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion. Which of the following results indicates that the heparin infusion should be increased?

• A. aPTT of 90 seconds
• B. Platelet count of 150,000/mm³
• C. INR of 1.0
• D. Hgb of 15 g/dL

Correct answer: A

Rationale: An aPTT of 90 seconds is above the therapeutic range for heparin, which typically falls between 60-80 seconds. This indicates that the current heparin dose is too high, and the infusion rate should be decreased to avoid excessive anticoagulation and the risk of bleeding. Monitoring aPTT is crucial in adjusting heparin therapy to maintain it within the therapeutic range.

3. A client is taking oral Oxycodone and Ibuprofen. The nurse should identify that an interaction between these two medications will cause which of the following findings?

• A. A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of this medication.
• B. A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of this medication.
• C. An increase in the expected therapeutic effect of both medications.
• D. An increase in expected adverse effects for both medications.

Correct answer: C

Rationale: The interaction between oxycodone and ibuprofen results in an increase in the expected therapeutic effect of both medications. Oxycodone is a narcotic analgesic, while ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). They work through different mechanisms but complement each other in pain management. When taken together, they can enhance the pain-relieving effects of each other, providing better pain relief for the client.

4. When teaching a client with a new prescription for warfarin, which statement should the nurse include?

• A. Avoid using a soft toothbrush.
• B. Avoid foods high in vitamin K.
• C. Report any signs of bleeding to your provider.
• D. Use an electric shaver for shaving.

Correct answer: C

Rationale: The correct statement the nurse should include when teaching a client with a new prescription for warfarin is to report any signs of bleeding to their provider. Bleeding can indicate excessive anticoagulation, a potential side effect of warfarin therapy that needs prompt medical attention. Choices A, B, and D are incorrect because while oral hygiene measures, dietary considerations, and skin care are important, they are not the priority when teaching a client about warfarin therapy. Monitoring for and reporting signs of bleeding is crucial due to the anticoagulant effects of warfarin.

5. When teaching a client who has a prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Take the medication at bedtime.
• B. Monitor for a persistent cough.
• C. Expect to have increased appetite.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: The correct answer is B: 'Monitor for a persistent cough.' Lisinopril, an ACE inhibitor, can cause a persistent dry cough as a side effect. It is essential for the client to report this symptom to their healthcare provider for further evaluation and management. Choice A is incorrect because Lisinopril is typically taken in the morning. Choice C is incorrect as Lisinopril is not known to cause increased appetite. Choice D is also incorrect as Lisinopril can lead to increased potassium levels in the blood, so avoiding foods high in potassium is not necessary.

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