Nursing Elites

1. Phenytoin is an antiarrhythmic and anticonvulsant that has an unlabeled use for:

• A. Headaches
• B. Cold remedy
• C. Neuropathic pain
• D. Antianxiety

Correct answer: C

Rationale: Phenytoin, an antiarrhythmic and anticonvulsant medication, is also used off-label for treating neuropathic pain. While its primary indications are for managing heart rhythm disorders and seizures, it has shown efficacy in managing neuropathic pain, expanding its clinical utility. Choices A, B, and D are incorrect as phenytoin is not commonly used for headaches, cold remedies, or antianxiety purposes.

2. A client in a long-term care facility has Hypothyroidism and a new prescription for Levothyroxine. Which of the following dosage schedules should the nurse expect for this client?

• A. The client will start at a high dose, and the dose will be tapered as needed.
• B. The client will remain on the initial dosage during the course of treatment.
• C. The client's dosage will be adjusted daily based on blood levels.
• D. The client will start on a low dose, which will be gradually increased.

Correct answer: D

Rationale: The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This cautious approach is crucial, especially in older adult clients, to prevent toxicity and ensure optimal therapeutic outcomes for managing hypothyroidism. Choice A is incorrect because starting at a high dose and tapering as needed is not the standard approach for levothyroxine. Choice B is incorrect because the initial dosage is typically adjusted to reach the optimal therapeutic dose. Choice C is incorrect as adjusting the dosage daily based on blood levels is not necessary for levothyroxine, as it has a long half-life and requires time to reach a steady state.

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

• A. Take the medication with a full glass of water.
• B. Avoid activities that require alertness.
• C. Increase your intake of high-fiber foods.
• D. Expect your stools to be black and tarry.

Correct answer: B

Rationale: The correct answer is B. Loperamide can cause drowsiness and dizziness, so clients should avoid activities that require alertness until they know how the medication affects them. Taking the medication with a full glass of water can help with absorption. Increasing intake of high-fiber foods is not directly related to Loperamide. Black, tarry stools are not expected side effects of this medication, so informing the client to expect this is incorrect.

4. A healthcare provider plans to administer Morphine IV to a postoperative client. Which of the following actions should the provider take?

• A. Monitor for seizures and confusion with repeated doses.
• B. Protect the client's skin from severe diarrhea associated with morphine.
• C. Withhold this medication if the respiratory rate is less than 12/min.
• D. Administer Morphine intermittently via IV bolus over 30 seconds or less.

Correct answer: C

Rationale: The correct action for the provider is to withhold morphine if the client's respiratory rate is 12/min or less. Respiratory depression is a serious side effect of morphine and other opioids. Withholding the medication and informing the healthcare provider is essential to prevent further respiratory compromise in the client. Choices A, B, and D are incorrect because monitoring for seizures and confusion, protecting the client's skin from severe diarrhea, and administering morphine via IV bolus over 30 seconds or less are not the primary actions to ensure client safety when administering morphine IV. Respiratory status is crucial due to the risk of respiratory depression associated with opioid administration.

5. A client has a new prescription for Nitroglycerin to treat angina. Which of the following instructions should be included?

• A. Take this medication only when experiencing chest pain.
• B. Store the medication in a cool, dry place.
• C. Apply the patch to a different site each time.
• D. Do not cut the patch regardless of your blood pressure.

Correct answer: C

Rationale: When using Nitroglycerin patches to treat angina, it is crucial to apply the patch to a different site each time. This practice helps prevent skin irritation and ensures proper absorption of the medication, optimizing its effectiveness in managing angina symptoms.

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