Nursing Elites

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

• A. Increase your intake of high-fiber foods.
• B. Take the medication with grapefruit juice.
• C. Expect to feel drowsy or lightheaded.
• D. Avoid dairy products while taking this medication.

Correct answer: A

Rationale: The correct instruction to include when a client is prescribed Verapamil is to increase their intake of high-fiber foods. Verapamil can cause constipation as a side effect, and increasing fiber intake can help prevent constipation. High-fiber foods promote bowel regularity and can counteract the constipating effects of Verapamil. Choices B, C, and D are incorrect because taking Verapamil with grapefruit juice can lead to adverse reactions, drowsiness or lightheadedness is not a typical side effect of Verapamil, and there is no need to avoid dairy products specifically while taking this medication.

2. 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.

3. When teaching a client with a new prescription for warfarin, which statement should the nurse include?

• A. Avoid using a soft toothbrush.
• B. Avoid foods high in vitamin K.
• C. Report any signs of bleeding to your provider.
• D. Use an electric shaver for shaving.

Correct answer: C

Rationale: The correct statement the nurse should include when teaching a client with a new prescription for warfarin is to report any signs of bleeding to their provider. Bleeding can indicate excessive anticoagulation, a potential side effect of warfarin therapy that needs prompt medical attention. Choices A, B, and D are incorrect because while oral hygiene measures, dietary considerations, and skin care are important, they are not the priority when teaching a client about warfarin therapy. Monitoring for and reporting signs of bleeding is crucial due to the anticoagulant effects of warfarin.

4. A client has a new prescription for Oxycodone/Acetaminophen. Which of the following instructions should be included in the discharge teaching?

• A. Take the medication on an empty stomach.
• B. Avoid taking additional Acetaminophen while on this medication.
• C. Increase your intake of fiber while on this medication.
• D. Avoid taking the medication before bedtime.

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid taking additional Acetaminophen while on Oxycodone/Acetaminophen. This is important to prevent exceeding the maximum recommended dose and reducing the risk of liver toxicity. Oxycodone/Acetaminophen already contains Acetaminophen, so additional intake can lead to an overdose of this component. Choices A, C, and D are incorrect. Taking the medication on an empty stomach or increasing fiber intake are not specific instructions related to this medication. Avoiding taking the medication before bedtime is not directly relevant to the combination of Oxycodone/Acetaminophen.

5. Which drug undergoes extensive first-pass hepatic metabolism?

• A. Heparin
• B. Insulin
• C. Propranolol
• D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

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