Nursing Elites

1. A client with rheumatoid arthritis is prescribed adalimumab. What instruction should the nurse include in the client's teaching plan?

• A. Avoid live vaccines while taking this medication.
• B. Take this medication with food to decrease gastrointestinal upset.
• C. Report any signs of infection to the healthcare provider.
• D. Avoid sunlight exposure while taking this medication.

Correct answer: A

Rationale: The correct instruction for a client prescribed adalimumab, which is an immunosuppressant medication, is to avoid live vaccines. Adalimumab can weaken the immune system, making live vaccines potentially harmful. It is essential to educate the client on this to prevent complications and ensure the effectiveness of the treatment.

2. A client with a productive cough and fever has been diagnosed with bacterial pneumonia and is being admitted to the unit from the emergency room. Which intervention should the practical nurse ensure has been done prior to the administration of antibiotics?

• A. Sputum specimen
• B. Set of vital signs
• C. Electrocardiogram
• D. Glucometer check

Correct answer: A

Rationale: Before initiating antibiotic therapy in a client with bacterial pneumonia, obtaining a sputum specimen for culture and sensitivity is essential. This helps identify the specific bacteria causing the infection and guides the selection of the most effective antibiotic treatment.

3. A male client receives a scopolamine transdermal patch 2 hours before surgery. Four hours after surgery, the client tells the nurse that he is experiencing pain and asks why the patch is not working. Which action should the nurse take?

• A. Advise the client that the effects of the medication have worn off
• B. Explain that the medication is not given to relieve pain
• C. Check for the correct placement of the patch on the client
• D. Offer to apply a new transdermal patch to address the pain

Correct answer: B

Rationale: The correct answer is B. Scopolamine is not a pain medication; it is commonly used to prevent nausea and vomiting, particularly in surgical settings. It works on the central nervous system to help control these symptoms, not to relieve pain. Therefore, it is important for the nurse to explain to the client that the medication is not intended to relieve pain but rather to manage other specific symptoms. Checking the correct placement of the patch is also important to ensure proper administration, but addressing the misconception about the medication's purpose is the priority in this scenario. Offering to apply a new patch would not address the client's pain as scopolamine is not meant for pain relief. Advising the client that the effects have worn off is inaccurate because the medication is not used for pain management.

4. While a client is receiving the medication haloperidol, which client data would indicate to the practical nurse that the medication is therapeutic?

• A. The client has maintained consistent weight loss of 2 pounds per week.
• B. The client has demonstrated a decrease in paranoid behaviors.
• C. The client's blood pressure has remained within normal limits.
• D. The client's fasting blood glucose has remained below 120 mg/dL.

Correct answer: B

Rationale: When a client is taking haloperidol, a therapeutic response involves a decrease in symptoms such as paranoia, hallucinations, delusions, and emotional excitement. These improvements indicate that the medication is effectively managing the client's condition. Monitoring for a reduction in paranoid behaviors helps the practical nurse assess the medication's effectiveness in addressing the client's psychiatric symptoms.

5. Phenytoin is prescribed for a client who has a seizure disorder. Which statement by the client needs to be clarified by the healthcare provider?

• A. I should notify the healthcare provider if the color of my urine turns pink.
• B. I should never stop taking this medication abruptly.
• C. I should monitor my glucose levels closely since I am diabetic.
• D. I should take the medicine with antacids if gastric upset occurs.

Correct answer: D

Rationale: The correct answer is D because antacids should not be taken with phenytoin as they can decrease its effects. Taking antacids with phenytoin is not recommended. Choice A is correct; pink discoloration of urine can occur with phenytoin use. Choice B is also correct; abruptly stopping phenytoin can lead to seizures. Choice C is correct; monitoring glucose levels is important as phenytoin can increase glucose levels. Therefore, the statement about using antacids with phenytoin needs clarification.

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