Nursing Elites

1. A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse reinforce in this client's teaching?

• A. Discontinue the medication if dizziness occurs.
• B. Avoid getting up quickly. Always rise slowly.
• C. Take the medication with or without food.
• D. Increase your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct instruction that the practical nurse should reinforce with a client prescribed nitrate isosorbide dinitrate is to avoid getting up quickly and to rise slowly. Nitrates can cause orthostatic hypotension, a sudden drop in blood pressure when changing positions. By rising slowly, the client can prevent the occurrence of orthostatic hypotension and its associated symptoms. Choices A, C, and D are incorrect because discontinuing the medication without consulting a healthcare provider can be dangerous, taking the medication with or without food does not impact its effectiveness, and increasing potassium intake is not directly related to the use of nitrate isosorbide dinitrate.

2. After receiving the third dose of a new oral anticoagulant prescription, which action should the nurse implement? Select all that apply.

• A. Notify the healthcare provider of the finding
• B. Provide a PRN NSAID for gum discomfort
• C. Review the most recent coagulation lab values
• D. Complete a medication variance report

Correct answer: C

Rationale: Reviewing the most recent coagulation lab values is crucial after receiving multiple doses of a new oral anticoagulant to ensure the patient is within the desired therapeutic range and to prevent adverse events related to over or under-anticoagulation. It is essential to monitor these values closely to adjust the dosage if needed. Notifying the healthcare provider of any concerning findings is important, but it may not be the immediate priority after receiving the third dose. Providing a PRN NSAID for gum discomfort is not typically indicated with oral anticoagulant therapy, as it may increase the risk of bleeding. Completing a medication variance report is more relevant in cases of medication errors or discrepancies, which may not apply in this scenario.

3. A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond?

• A. Glipizide is not an oral form of insulin and can be used only when some beta cell function is present.
• B. Glipizide is an oral form of insulin and is distributed, metabolized, and excreted in the same manner as insulin.
• C. Glipizide is an oral form of insulin and has the same actions and properties as intermediate insulin.
• D. Glipizide is not an oral form of insulin, but it is effective for those who are resistant to injectable insulins.

Correct answer: A

Rationale: The practical nurse should explain to the client that glipizide is not an oral form of insulin but an oral hypoglycemic agent. Glipizide works by enhancing pancreatic production of insulin when some beta cell function is present. It is not a replacement for insulin but helps the body produce more insulin. Therefore, it can be used when there is still some beta cell function present, unlike insulin which is used when there is a deficiency of endogenous insulin production.

4. Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better. Which explanation should the PN provide?

• A. It takes 1 to 4 weeks for antidepressant medications to become effective.
• B. The dosage may need to be increased; I will contact your health care provider.
• C. Depression is difficult to treat with drugs alone. Therapy sessions would enhance their effectiveness.
• D. Based on your child's response to this drug, the health care provider is reviewing your medication regimen.

Correct answer: A

Rationale: Antidepressant medications typically require 1 to 4 weeks to reach their full therapeutic effect. It is crucial to educate the family that during the initial week of treatment, the child may experience heightened anxiety. Therefore, it is important to wait for the medication to take its full course before assessing its effectiveness.

5. A client whose seizure disorder has been managed with phenytoin is admitted to the emergency department with status epilepticus. Which drug should the practical nurse anticipate being prescribed for administration to treat these seizures?

• A. Phenytoin
• B. Diazepam
• C. Phenobarbital
• D. Carbamazepine

Correct answer: B

Rationale: In the management of status epilepticus, which is a life-threatening condition of prolonged seizures, rapid intervention is crucial. Diazepam is the drug of choice for treating status epilepticus due to its fast onset of action and effectiveness in stopping seizures. It acts by enhancing the inhibitory neurotransmitter GABA to suppress seizure activity quickly. Phenytoin, although used for long-term seizure control, has a slower onset of action and is not the first-line medication for managing status epilepticus.

Similar Questions