Nursing Elites

1. What instruction should the nurse include in the teaching plan for a client prescribed etanercept for rheumatoid arthritis?

• A. Rotate injection sites to prevent irritation.
• B. Take this medication with food to reduce gastrointestinal upset.
• C. Avoid sunlight exposure while on this medication.
• D. Notify the healthcare provider of any signs of infection.

Correct answer: A

Rationale: The correct instruction for a client prescribed etanercept is to rotate injection sites to prevent irritation and ensure proper absorption. Changing sites will help prevent skin irritation and ensure that the medication is absorbed effectively. This practice also reduces the risk of injection site reactions and discomfort. It is essential to follow this instruction to promote optimal medication delivery and minimize adverse effects. Choice B is incorrect because etanercept can be taken with or without food, and it is not specifically indicated to be taken with food to reduce gastrointestinal upset. Choice C is incorrect as there is no specific association between etanercept and sunlight exposure. Choice D is incorrect because while it is important to notify the healthcare provider of signs of infection, this is not the primary instruction related to the administration of etanercept.

2. A client with anxiety is prescribed alprazolam. What instruction should the nurse include in the client's teaching plan?

• A. Take this medication with food.
• B. Avoid activities that require alertness.
• C. Do not stop taking this medication abruptly.
• D. This medication may cause drowsiness.

Correct answer: C

Rationale: The correct answer is C: 'Do not stop taking this medication abruptly.' Alprazolam should not be stopped suddenly as it can lead to withdrawal symptoms. It is important for clients to taper off the medication gradually under medical supervision to prevent adverse effects. Choices A, B, and D are incorrect. Choice A is irrelevant to alprazolam administration instructions. Choice B, 'Avoid activities that require alertness,' is not the priority teaching point for alprazolam. Choice D, 'This medication may cause drowsiness,' is a common side effect of alprazolam but not the most critical instruction to include in the teaching plan.

3. 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.

4. A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?

• A. The client is experiencing vision and hearing loss.
• B. The client has an erection lasting longer than 4 hours.
• C. The client is complaining of nasal congestion.
• D. The client is complaining of feeling flushed.

Correct answer: A

Rationale: The correct answer is A. If a client prescribed sildenafil for pulmonary hypertension experiences vision and/or hearing loss or an erection lasting more than 4 hours, the practical nurse should instruct the client to discontinue the medication immediately and notify the health care provider. These symptoms could indicate serious side effects that require prompt medical attention to prevent complications. Choices B, C, and D are incorrect because an erection lasting more than 2 hours (not 4 hours as stated in choice B) is a critical adverse effect that warrants immediate medical attention. Nasal congestion (choice C) and feeling flushed (choice D) are common side effects of sildenafil and typically do not necessitate immediate discontinuation of the medication or emergency intervention.

5. A client with heart failure develops hyperaldosteronism. What dietary recommendation is essential for managing this condition?

• A. Limit intake of high potassium foods
• B. Replace salt with salt substitute
• C. Monitor skin for excessive bruising
• D. Cover your skin before going outside

Correct answer: A

Rationale: Hyperaldosteronism can lead to increased potassium retention, which can be problematic for individuals with heart failure. Limiting intake of high potassium foods is crucial to prevent hyperkalemia, a condition that can worsen heart failure. Therefore, advising the client to limit high potassium foods is essential in managing hyperaldosteronism in the setting of heart failure.

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