Nursing Elites

1. The client with Raynaud's phenomenon is being taught by the nurse about preventing episodes. Which instruction should the nurse reinforce?

• A. Wear gloves in cold weather.
• B. Avoid caffeine and chocolate.
• C. Increase intake of vitamin C.
• D. Use a heating pad for warmth.

Correct answer: A

Rationale: The correct answer is A: 'Wear gloves in cold weather.' Wearing gloves in cold weather is essential for preventing vasoconstriction and subsequent episodes of Raynaud's phenomenon. Cold temperatures can trigger vasospasms in individuals with Raynaud's, and wearing gloves helps maintain warmth and prevent the constriction of blood vessels in the extremities, reducing the likelihood of an episode. Choices B, C, and D are incorrect because while avoiding caffeine and chocolate, increasing vitamin C intake, and using a heating pad for warmth can be beneficial for overall health, they are not specifically targeted at preventing Raynaud's phenomenon episodes triggered by cold weather.

2. A client is admitted with an arterial ischemic leg ulcer. The nurse expects to note that this ulcer has which typical characteristic?

• A. Dark pink base
• B. Deep and painful
• C. Accompanied by very slight pain
• D. Brown pigmentation of surrounding skin

Correct answer: B

Rationale: Arterial ischemic ulcers are typically characterized by being deep and painful, often with a pale or necrotic base. The lack of adequate blood flow leads to tissue damage, resulting in these ulcers having a deep appearance and causing significant pain to the individual. The other options are not commonly associated with arterial ischemic ulcers; a dark pink base, very slight pain, or brown pigmentation of surrounding skin are not typical features of this type of ulcer.

3. A hypertensive client who has been taking metoprolol (Lopressor) has been prescribed to decrease the dose of the medication. The client asks the nurse why this must be done over a period of 1 to 2 weeks. In formulating a response, the nurse incorporates the understanding that abrupt withdrawal could affect the client in which way?

• A. Result in hypoglycemia
• B. Give the client insomnia
• C. Precipitate rebound hypertension
• D. Cause enhanced side effects of other prescribed medications

Correct answer: C

Rationale: Abruptly stopping metoprolol can lead to rebound hypertension, causing a sudden increase in blood pressure due to the sudden withdrawal of the medication. Gradually tapering the dose helps the body adjust and reduces the risk of this adverse effect. Choices A, B, and D are incorrect. Stopping metoprolol suddenly is not known to result in hypoglycemia, insomnia, or enhanced side effects of other medications.

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

• A. Monitor your heart rate daily.
• B. Take the medication at bedtime.
• C. Avoid consuming grapefruit juice.
• D. Take the medication with food.

Correct answer: A

Rationale: The correct answer is to instruct the client to monitor their heart rate daily when taking verapamil. Verapamil is a calcium channel blocker that can cause bradycardia, making it crucial to monitor the heart rate regularly to detect any changes promptly. Choice B, taking the medication at bedtime, is not specifically related to verapamil administration. Choice C, avoiding grapefruit juice, is more relevant to medications metabolized by CYP3A4 enzymes, not verapamil. Choice D, taking the medication with food, is not a specific instruction for verapamil, as it can be taken with or without food.

5. A healthcare professional is assessing a client who has a new prescription for warfarin. Which of the following findings should the healthcare professional report to the provider?

• A. Weight gain
• B. Frequent urination
• C. Hypokalemia
• D. Bleeding gums

Correct answer: D

Rationale: Bleeding gums are a sign of excessive anticoagulation with warfarin, indicating a potential risk of bleeding complications. It is crucial to report this finding promptly to the provider for further assessment and adjustment of the medication regimen to prevent serious bleeding events. Weight gain, frequent urination, and hypokalemia are not typically associated with warfarin use and are not immediate concerns that require urgent reporting to the provider.

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