Nursing Elites

1. A client has a new prescription for methotrexate. Which of the following instructions should the nurse include?

• A. Avoid consuming dairy products.
• B. Take the medication on an empty stomach.
• C. Increase your intake of folic acid.
• D. Monitor for signs of hyperglycemia.

Correct answer: C

Rationale: Increasing folic acid intake is crucial when taking methotrexate because the medication can lead to folic acid deficiency. Folic acid supplementation helps counteract this deficiency and reduces the risk of adverse effects associated with methotrexate therapy. Choices A, B, and D are incorrect. Avoiding dairy products is not specifically necessary for methotrexate therapy. Methotrexate is usually taken with food to reduce gastrointestinal side effects, so taking it on an empty stomach is not recommended. Monitoring for signs of hyperglycemia is not directly related to methotrexate use.

2. The client with chronic stable angina is prescribed a beta blocker. The nurse is reinforcing instructions. What instruction should the nurse include?

• A. Take the medication with a meal.
• B. Report a pulse rate below 60 beats per minute.
• C. Discontinue the medication if dizziness occurs.
• D. Avoid drinking grapefruit juice.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to report a pulse rate below 60 beats per minute. Beta blockers are known to lower heart rate, and a pulse rate below 60 beats per minute may indicate bradycardia, a condition that requires medical attention. Option A, 'Take the medication with a meal,' is incorrect because beta blockers don't necessarily need to be taken with food. Option C, 'Discontinue the medication if dizziness occurs,' is incorrect because abrupt cessation of beta blockers can lead to rebound hypertension and other adverse effects. Option D, 'Avoid drinking grapefruit juice,' is unrelated to beta blockers' mechanism of action or side effects.

3. A healthcare professional is providing discharge teaching to a client who has a new prescription for enoxaparin. Which of the following instructions should the healthcare professional include?

• A. Administer the injection into the abdomen.
• B. Avoid massaging the injection site after administration.
• C. Expect mild bruising at the injection site.
• D. Avoid alternating injection sites between the arms.

Correct answer: A

Rationale: Administering enoxaparin into the abdomen is recommended to ensure proper absorption and effectiveness. Massaging the injection site after administration should be avoided as it can increase the risk of bleeding or bruising. Mild bruising at the injection site is common with enoxaparin and should be expected. Alternating injection sites, especially between arms, is not suitable for enoxaparin administration. Consistent administration into the abdomen is preferred for consistent absorption of the medication.

4. When educating a client about the use of risedronate to treat osteoporosis, which instruction should be included?

• A. Drink a full glass of water with each dose.
• B. Take the medication on an empty stomach.
• C. Remain upright for 30 minutes after taking the medication.
• D. Avoid lying down for at least 1 hour after taking the medication.

Correct answer: C

Rationale: The correct instruction for a client taking risedronate to treat osteoporosis is to remain upright for 30 minutes after taking the medication. This is important to prevent esophageal irritation, as risedronate can cause irritation if it remains in contact with the esophagus. By staying upright, the medication is more likely to reach the stomach quickly and reduce the risk of irritation to the esophagus. Choices A, B, and D are incorrect. Drinking a full glass of water is recommended, not milk, to help with swallowing the medication. Risedronate should be taken on an empty stomach, not with meals, to ensure proper absorption. Additionally, avoiding lying down for at least 1 hour after taking the medication helps prevent esophageal irritation.

5. A client has a new prescription for transdermal nitroglycerin patches. Which of the following instructions should be included for proper use?

• A. Apply the patch to the same site each day.
• B. Place the patch on an area of skin away from skin folds and joints.
• C. Keep the patch on 24 hours per day.
• D. Replace the patch every 72 hours.

Correct answer: B

Rationale: Placing the nitroglycerin patch on an area of skin away from skin folds and joints is crucial to ensure optimal absorption and effectiveness of the medication. Placing the patch on skin folds or joints can interfere with absorption, potentially reducing the patch's efficacy. Therefore, it is essential to follow this instruction to maximize the therapeutic benefits of the nitroglycerin patches. The other options are incorrect because applying the patch to the same site each day can lead to skin irritation, keeping the patch on 24 hours per day may not be necessary depending on the specific patch instructions, and replacing the patch every 72 hours is not the standard frequency for nitroglycerin patches.

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