Nursing Elites

1. A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take?

• A. Obtain a blood specimen immediately prior to administering the next dose of medication.
• B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen.
• C. Ask the client to provide a urine specimen after the next dose of medication.
• D. Administer the medication and obtain a blood specimen 30 minutes later.

Correct answer: A

Rationale: To verify the trough levels of a medication accurately, the nurse should obtain a blood specimen immediately before administering the next dose of the medication. The trough level represents the lowest concentration of the medication in the bloodstream, typically right before the next dose is due. This timing ensures an accurate assessment of the drug's concentration in the body at its lowest point, aiding in determining the drug's effectiveness and potential toxicity levels. Choice B is incorrect because waiting for 24 hours would not provide the trough level. Choice C is incorrect as urine specimens are not used to measure trough levels. Choice D is incorrect as obtaining a blood specimen 30 minutes after administering the medication would not reflect the trough level.

2. A healthcare professional is reviewing the medication list of a client scheduled for surgery. Which of the following medications places the client at risk for increased bleeding during surgery?

• A. Warfarin
• B. Acetaminophen
• C. Ibuprofen
• D. Aspirin

Correct answer: D

Rationale: Aspirin is an anticoagulant that inhibits platelet function, increasing the risk of bleeding during surgery. It is important for the healthcare professional to identify this medication, inform the surgical team, and consider withholding it prior to surgery to reduce the risk of excessive bleeding. Warfarin is also an anticoagulant but can be managed by adjusting the dosage or monitoring INR levels. Acetaminophen and ibuprofen are not associated with increased bleeding risk as they do not affect platelet function like aspirin.

3. A client has a new prescription for transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

• A. I will clean the site with an alcohol swab before applying the patch.
• B. I will rotate the application sites weekly.
• C. I will apply the patch to an area of skin with no hair.
• D. I will place the new patch where the old patch was.

Correct answer: C

Rationale: The correct answer is C because applying the patch to an area of skin without hair ensures better absorption of the medication. Hair can interfere with the patch's adherence and effectiveness. It is important for the client to choose a clean, hairless area for proper medication delivery. Choices A, B, and D are incorrect. Cleaning the site with an alcohol swab is a good practice but does not specifically indicate understanding of proper patch application. Rotating application sites weekly is important to prevent skin irritation but is not directly related to applying the patch to an area of skin without hair. Placing the new patch where the old patch was may lead to skin irritation and poor absorption of the medication.

4. A client is being educated by a healthcare provider about managing Digoxin toxicity. Which statement by the client demonstrates an understanding of the teaching?

• A. I will take an extra dose of Digoxin if I miss one.
• B. I should notify my healthcare provider if I experience visual changes.
• C. I will stop taking Digoxin if my heart rate is below 70 bpm.
• D. I should take antacids to alleviate gastrointestinal upset.

Correct answer: B

Rationale: The correct answer is B. Visual changes, such as yellow or blurred vision, can be indicative of digoxin toxicity. It is crucial for clients to inform their healthcare provider promptly if they encounter these symptoms. Prompt medical attention can help manage potential toxicity and prevent complications. Choices A, C, and D are incorrect because taking an extra dose of Digoxin, stopping Digoxin based on heart rate alone, and using antacids for gastrointestinal upset are not appropriate actions when managing Digoxin toxicity.

5. 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 client using a Nitroglycerin transdermal patch is to remove the patch each day, usually at bedtime, to prevent tolerance. This practice allows for a nitrate-free interval, reducing the risk of developing tolerance to the medication. Applying the patch to a different site each day (choice A) is not necessary as long as the skin is clean and rotated to avoid skin irritation. Applying the patch over an area with little or no hair (choice C) does not impact the effectiveness of the medication. Keeping the patch on for 24 hours at a time (choice D) can lead to tolerance, which is why the patch should be removed daily.

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