Nursing Elites

1. A client with Bipolar disorder has a new prescription for Carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

• A. This medication can safely be taken during pregnancy.
• B. Eliminate grapefruit juice from your diet.
• C. You will need to have a complete blood count and carbamazepine levels drawn periodically.
• D. Notify your provider if you develop a rash.

Correct answer: B

Rationale: The correct answer is B: "Eliminate grapefruit juice from your diet." Grapefruit juice affects carbamazepine metabolism and should be avoided. It can lead to increased levels of the medication, potentially causing toxicity. Monitoring carbamazepine blood levels and the complete blood count (CBC) is essential to ensure the medication's efficacy and safety. Although choice A is incorrect (This medication can safely be taken during pregnancy), carbamazepine is classified as a Pregnancy Category D drug, which means there is positive evidence of human fetal risk. Choice D (Notify your provider if you develop a rash) is also important because carbamazepine can cause serious adverse effects like Stevens-Johnson syndrome, which can be life-threatening. Regular monitoring and prompt reporting of any rash are crucial. Therefore, choices C and D are also relevant instructions for the client.

2. A healthcare professional is reviewing the medication administration record for a client who is receiving transdermal Fentanyl for severe pain. Which of the following medications should the healthcare professional expect to cause an adverse effect when administered concurrently with Fentanyl?

• A. Ampicillin
• B. Diazepam
• C. Furosemide
• D. Prednisone

Correct answer: B

Rationale: Diazepam, a CNS depressant, can lead to severe sedation when administered concurrently with an opioid like Fentanyl due to their additive central nervous system depressant effects. This interaction can potentiate respiratory depression and other CNS effects, increasing the risk of adverse outcomes.

3. A client has a new prescription for Albuterol and Beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?

• A. Take the albuterol at the same time each day.
• B. Administer the albuterol inhaler before using the beclomethasone inhaler.
• C. Use beclomethasone if experiencing an acute episode.
• D. Avoid shaking the beclomethasone before use.

Correct answer: B

Rationale: When a client is prescribed an inhaled beta2-agonist (such as albuterol) and an inhaled glucocorticoid (such as beclomethasone) for asthma control, the beta2-agonist should be administered first. Administering the beta2-agonist before the glucocorticoid helps promote bronchodilation and enhances the absorption of the glucocorticoid, maximizing its effectiveness in the lungs. Choice A is incorrect because albuterol is usually taken as needed for quick relief of asthma symptoms and not necessarily at the same time each day. Choice C is incorrect as beclomethasone is a controller medication used for long-term asthma management, not for acute episodes. Choice D is incorrect as shaking the beclomethasone inhaler before use helps ensure proper medication dispersion for effective inhalation.

4. A client has a new prescription for Folic Acid. Which of the following client statements indicates an understanding of the teaching?

• A. I will take this medication with food.
• B. I need to monitor for skin rash while taking this medication.
• C. I need to increase my intake of green, leafy vegetables.
• D. I will stop taking this medication if I feel nauseous.

Correct answer: C

Rationale: The correct answer is C. Folic acid is naturally found in green, leafy vegetables such as spinach and broccoli. Increasing the intake of these vegetables can supplement the prescribed folic acid and help maintain adequate levels in the body. It is essential to understand that dietary sources of folic acid can complement the medication and support overall health. Choices A, B, and D are incorrect because taking folic acid with food, monitoring for skin rash, or stopping the medication if feeling nauseous do not directly relate to enhancing the therapeutic effects of folic acid through dietary intake.

5. What is the action of Nitroglycerin?

• A. Dilates the Bronchi
• B. Reduces Blood Glucose
• C. Reduces Nausea
• D. Dilates Coronary Arteries

Correct answer: D

Rationale: Nitroglycerin acts by dilating the coronary arteries, leading to increased blood flow and oxygen supply to the heart. This helps in relieving angina symptoms by reducing the heart's workload and improving blood supply to the myocardium. Choices A, B, and C are incorrect because Nitroglycerin's primary action is not related to dilating bronchi, reducing blood glucose, or reducing nausea.

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