Nursing Elites

1. A client has a new prescription for Propranolol. Which of the following statements should the nurse include in teaching the client?

• A. You may experience a rapid heart rate while taking this medication.
• B. Take the medication with food.
• C. Avoid sudden changes in position.
• D. Increase your intake of high-sodium foods.

Correct answer: C

Rationale: The correct statement to include when teaching a client about Propranolol is to avoid sudden changes in position. Propranolol, a beta-blocker, can lead to dizziness and lightheadedness, particularly when changing positions. Therefore, clients should be advised to change positions slowly to prevent falls and related injuries. Choice A is incorrect because Propranolol actually helps lower heart rate and blood pressure. Choice B is not a specific requirement for taking Propranolol. Choice D is also incorrect as increasing high-sodium foods is not recommended with Propranolol which can affect blood pressure control.

2. A client with migraine headaches is starting prophylaxis therapy with Propranolol. Which finding in the client's history should the nurse report to the provider?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with first-degree heart block due to its negative inotropic and chronotropic effects. The nurse should report this finding to the provider to consider an alternative therapy to prevent potential worsening of cardiac conduction abnormalities. Choices A, B, and C are not directly contraindications to Propranolol therapy for migraine headaches and do not pose immediate risks that would require reporting to the provider.

3. A healthcare provider is caring for several clients who came to the clinic for a seasonal influenza immunization. The provider should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection?

• A. 1-year-old who has no health problems
• B. 17-year-old who has a hypersensitivity to Penicillin
• C. 25-year-old who is pregnant
• D. 52-year-old who takes a multivitamin supplement

Correct answer: B

Rationale: The correct answer is B. A 17-year-old can receive the influenza vaccine via nasal spray even if they have a hypersensitivity to penicillin, as this is not a contraindication for the influenza immunization. The nasal spray vaccine (LAIV) is a live attenuated vaccine that is suitable for healthy individuals aged 2-49 years. Pregnancy (choice C) is a contraindication for the nasal spray influenza vaccine. Children under 2 years of age (choice A) are also not candidates for the nasal spray. Taking a multivitamin supplement (choice D) is not a determining factor for the type of influenza vaccine a person should receive.

4. A client is receiving discharge instructions for long-term use of Prednisone. Which of the following instructions should be included?

• A. Stop taking the medication if you experience swelling.
• B. The provider will monitor your weight regularly.
• C. Take the medication on an empty stomach.
• D. You may notice decreased appetite while on this medication.

Correct answer: B

Rationale: The correct answer is B because long-term use of Prednisone can lead to weight gain, necessitating regular weight monitoring by the healthcare provider to manage any potential complications. Prednisone often causes fluid retention, leading to weight gain, hence the need for weight monitoring. Options A, C, and D are incorrect because swelling is not a typical reason to stop Prednisone, taking it on an empty stomach is not usually required, and Prednisone commonly increases appetite rather than decreases it.

5. A healthcare provider is educating a client who has a prescription for Theophylline. Which of the following instructions should the healthcare provider include?

• A. Avoid caffeine while taking this medication.
• B. You should increase your fluid intake.
• C. Take this medication in the evening.
• D. You may experience increased appetite while on this medication.

Correct answer: A

Rationale: The correct answer is A: 'Avoid caffeine while taking this medication.' Caffeine can increase the risk of theophylline toxicity as it competes for the same metabolic pathways. Consuming caffeine while on theophylline can lead to adverse effects. Choice B is incorrect because although maintaining adequate hydration is important, it is not a specific instruction related to theophylline use. Choice C is incorrect as the timing of the medication administration should be based on the healthcare provider's recommendation and the client's individual needs. Choice D is incorrect as increased appetite is not a common side effect associated with theophylline.

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