Nursing Elites

1. A female client who started chemotherapy three days ago for cancer of the breast calls the clinic reporting that she is so upset she cannot sleep. The client has several PRN medications available. Which drug should the nurse instruct her to take?

• A. Ondansetron 8mgPO no
• B. Lorazepam 2mg PO bedtime
• C. Oxycodone, acetylsalicylic acid one tablet q4 hours PRN
• D. Acetaminophen, diphenhydramine 2 capsules bedtime

Correct answer: D

Rationale: Acetaminophen and diphenhydramine help with sleep without severe side effects.

2. A client with asthma is prescribed montelukast. The nurse should instruct the client that this medication is used for which purpose?

• A. Immediate relief of acute asthma attacks
• B. Long-term control of asthma symptoms
• C. Treatment of exercise-induced bronchospasm
• D. Immediate relief of allergic rhinitis symptoms

Correct answer: B

Rationale: Montelukast is a leukotriene receptor antagonist used for the long-term control of asthma symptoms by reducing inflammation in the airways. It is not typically used for immediate relief during acute asthma attacks, where short-acting bronchodilators are more appropriate. Montelukast does not specifically target exercise-induced bronchospasm or allergic rhinitis symptoms. Therefore, the correct answer is B. Choice A is incorrect because montelukast is not for immediate relief of acute asthma attacks. Choice C is incorrect as montelukast is not primarily used to treat exercise-induced bronchospasm. Choice D is incorrect because montelukast is not indicated for immediate relief of allergic rhinitis symptoms.

3. During a home visit, a client with a history of angina reports frequent headaches. The client recently started a new prescription for diltiazem, a calcium channel blocker. What action should the nurse take?

• A. Explain the importance of obtaining a blood sample promptly to test for medication toxicity
• B. Consult with the healthcare provider regarding the necessity of an opioid analgesic for pain relief
• C. Recommend the client to discontinue the medication until contacting the healthcare provider
• D. Instruct the client on the use of acetaminophen every 4-6 hours as needed for headaches

Correct answer: D

Rationale: The correct action for the nurse to take is to instruct the client to use acetaminophen for headaches. Acetaminophen is a suitable and safer option for managing headaches associated with calcium channel blockers like diltiazem. It is essential to avoid medications that can interact negatively with diltiazem, such as opioid analgesics. Discontinuing the medication abruptly without consulting the healthcare provider is not recommended. Monitoring for medication toxicity through blood samples is not typically indicated for managing headaches in this scenario.

4. A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

• A. Dilute the available heparin in 250ml of normal saline solution prior to IV administration
• B. Advise the pharmacy on the need to deliver a vial of heparin to the nursing unit immediately
• C. Calculate and administer the equivalent dose of the available low molecular weight heparin
• D. Request a prescription to change the route of administration and use the available heparin

Correct answer: B

Rationale: In this scenario, the nurse should contact the pharmacy to obtain the correct heparin formulation as the prescription calls for heparin 1,000 units IV STAT. Low molecular weight heparin is not the same as unfractionated heparin, and therefore, the nurse should not administer the available low molecular weight heparin without first obtaining the correct medication. Diluting the available heparin, calculating an equivalent dose, or changing the route of administration would not address the discrepancy between the prescribed heparin and the available low molecular weight heparin.

5. The healthcare professional is creating a class for older adults in the community. Which information about laxative use in older adults would be important to include?

• A. Laxatives are not effective in older adults
• B. All laxatives are exactly the same
• C. Over-the-counter laxatives are misused
• D. Laxatives can cause potassium retention

Correct answer: C

Rationale: It is important to include information about the misuse of over-the-counter laxatives in older adults as they often misuse these medications, which can lead to dependency and other health issues. Option A is incorrect as laxatives can be effective in older adults when used appropriately. Option B is incorrect because not all laxatives are the same, they have different mechanisms of action and side effects. Option D is incorrect because laxatives can actually cause electrolyte imbalances like potassium depletion rather than retention.

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