Nursing Elites

1. A client has a new prescription for a Nitroglycerin transdermal patch. Which of the following instructions should the nurse include?

• A. Apply the patch to a different site each day.
• B. Remove the patch at bedtime each day.
• C. Apply the patch over an area with little or no hair.
• D. Keep the patch on for 24 hours at a time.

Correct answer: B

Rationale: The correct instruction for a Nitroglycerin transdermal patch is to remove it each day, usually at bedtime, to prevent tolerance. Keeping the patch on for 24 hours at a time can lead to tolerance development. Applying the patch to a different site each day is not necessary, as long as the area is rotated to prevent skin irritation. Applying the patch over an area with little or no hair is not a critical instruction for the Nitroglycerin patch.

2. A client in the emergency department has Benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority?

• A. Administer flumazenil.
• B. Identify the client's level of orientation.
• C. Infuse IV fluids.
• D. Prepare the client for gastric lavage.

Correct answer: B

Rationale: In a situation where a client presents with Benzodiazepine toxicity, the priority action for the nurse is to assess the client. By identifying the client's level of orientation, the nurse can gather crucial information about the client's mental status, which is essential for determining the appropriate care and interventions needed. Administering flumazenil is used to reverse the effects of benzodiazepines but should be based on a comprehensive assessment. Infusing IV fluids and preparing for gastric lavage may be necessary interventions but should follow a thorough assessment of the client's condition to ensure proper prioritization of care.

3. A client with Addison's disease is being admitted for a total hip arthroplasty. The client takes hydrocortisone. What is the nurse's priority action?

• A. Administering a supplemental dose of hydrocortisone
• B. Instructing the client about coughing and deep breathing
• C. Collecting additional information from the client about his history of Addison's disease
• D. Inserting an indwelling urinary catheter

Correct answer: A

Rationale: The priority action for a client with Addison's disease undergoing surgery who takes hydrocortisone is to administer a supplemental dose of hydrocortisone. Acute adrenal insufficiency (adrenal crisis) is a significant risk during surgery due to the stress placed on the body. Supplemental doses help prevent acute adrenal insufficiency and ensure the client's safety during the surgical procedure. Instructing the client about coughing and deep breathing is important post-operatively but not the priority before surgery. Collecting additional information about the client's history of Addison's disease is relevant but not the priority action before surgery. Inserting an indwelling urinary catheter is not the priority action in this scenario.

4. A client has a new prescription for Spironolactone. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia due to its mechanism of action. Hyperkalemia can cause muscle weakness and cardiac dysrhythmias. Therefore, the nurse should educate the client to monitor for signs and symptoms of hyperkalemia while taking Spironolactone.

5. A client has a new prescription for Metoprolol to treat hypertension. Which of the following instructions should the nurse include?

• A. Stop taking the medication if your heart rate is below 70/min.
• B. Take the medication with food.
• C. Avoid sudden changes in position.
• D. Limit your sodium intake while taking this medication.

Correct answer: C

Rationale: The correct instruction for a client taking Metoprolol, a medication used to treat hypertension, is to avoid sudden changes in position. Metoprolol can cause orthostatic hypotension, a sudden drop in blood pressure when moving from lying down to standing up, leading to dizziness and falls. By advising the client to change positions slowly, the nurse helps prevent these adverse effects and promotes safety.

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