Nursing Elites

1. A client with OCD has a new prescription for Paroxetine. Which of the following instructions should the nurse include?

• A. It can take several weeks before you feel like the medication is helping.
• B. Take the medication just before bedtime to promote sleep.
• C. You should take the medication when needed for obsessive urges.
• D. Monitor for weight gain while taking this medication.

Correct answer: A

Rationale: The correct answer is A. Paroxetine, an antidepressant commonly used for OCD, typically takes 1 to 4 weeks before the client experiences the full therapeutic benefit. Therefore, informing the client that it may take several weeks before feeling the medication's effects is crucial to manage expectations and ensure compliance with the treatment plan. Choice B is incorrect because Paroxetine is usually taken in the morning due to its activating effects and may cause insomnia if taken before bedtime. Choice C is incorrect because Paroxetine should be taken regularly as prescribed, not just when experiencing obsessive urges. Choice D is incorrect because although weight gain can be a side effect of Paroxetine, it is not a priority instruction compared to the delayed onset of therapeutic effects.

2. A client is prescribed an IM dose of penicillin. She reports developing a rash after taking penicillin 3 years ago. What action should the healthcare professional take?

• A. Administer the prescribed dose.
• B. Withhold the medication.
• C. Ask the provider to change the prescription to an oral form.
• D. Administer an oral antihistamine at the same time.

Correct answer: B

Rationale: The healthcare professional should withhold the medication and notify the provider of the client's previous reaction to penicillin. It is crucial to report any past allergic reactions to medications, as this information guides the provider in prescribing a safe alternative. Administering the prescribed dose without considering the client's history of developing a rash can lead to potentially severe adverse reactions. Changing the prescription to an oral form or administering an oral antihistamine does not address the risk of an allergic reaction to penicillin in this case.

3. Why should the nitrate patch be off for 8 hours per day?

• A. “There is no reason to take the patch off each day.”
• B. “The patch can be addictive; leaving it off reduces the addiction.”
• C. “You should only leave the patch off for 15 minutes.”
• D. “Leaving the patch off for 8 hours per day helps to delay the development of tolerance.”

Correct answer: D

Rationale: Removing the nitrate patch for 8 hours each day is essential to prevent the body from developing tolerance to the medication. By allowing the body to have a drug-free period, the effectiveness of the medication is maintained over time. This practice helps in ensuring that the nitrate patch continues to provide its intended therapeutic effects without diminishing its efficacy. Therefore, it is important for the client to adhere to the prescribed schedule of removing the patch for 8 hours daily to optimize the treatment outcomes.

4. A client has a new prescription for Etanercept for Rheumatoid Arthritis. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will need to get my blood drawn periodically while on this medication.
• B. I should stop taking this medication if I develop a rash.
• C. I will need to limit my alcohol intake to no more than one drink per week.
• D. I should self-administer this medication subcutaneously.

Correct answer: A

Rationale: The correct answer is A because Etanercept can cause bone marrow suppression, so it is crucial to monitor blood counts regularly to detect any early signs of adverse effects.

5. A healthcare provider is providing discharge instructions to a client who has a new prescription for Warfarin. Which of the following over-the-counter medications should the provider instruct the client to avoid?

• A. Acetaminophen
• B. Ibuprofen
• C. Diphenhydramine
• D. Loratadine

Correct answer: B

Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding when taken with Warfarin due to its antiplatelet effects. The combination of Warfarin, an anticoagulant, and NSAIDs can potentiate the risk of bleeding complications. Clients on Warfarin should avoid NSAIDs like ibuprofen and opt for alternative pain relief options such as acetaminophen. Diphenhydramine and loratadine are antihistamines and are generally safe to use with Warfarin as they do not significantly increase the risk of bleeding when compared to NSAIDs like ibuprofen.

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