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A client with a history of chronic obstructive pulmonary disease (COPD) has been prescribed a new ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?
- A. The client primes the inhaler with 7 pumps.
- B. The client stores the medication at room temperature.
- C. The client rinses their mouth after each use.
- D. The client attaches a spacer device to the inhaler.
Correct Answer: A
Rationale: Ipratropium inhalers require 2-3 priming sprays for new devices, not 7 (A), indicating a need for teaching. Room temperature storage (B), mouth rinsing (C), and spacer use (D) are correct.
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The nurse administers naloxone to a patient with opioid-induced respiratory depression. An hour later, the nurse finds the patient has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unresponsive. What action should the nurse take?
- A. Administer a second dose of naloxone.
- B. Prepare to assist with chest tube insertion.
- C. Determine Glasgow Coma Scale score.
- D. Initiate cardiopulmonary resuscitation (CPR).
Correct Answer: D
Rationale: Severe respiratory depression (4 breaths/min), hypoxia (75% SpO₂), and unresponsiveness require immediate CPR (D) to restore circulation/oxygenation. A second naloxone dose (A) may be needed but is secondary. Chest tubes (B) are irrelevant. Glasgow scoring (C) delays critical intervention.
Rivastigmine, a cholinesterase inhibitor, is prescribed for a female patient with early-stage Alzheimer’s Disease. The patient’s daughter tells the nurse that she plans to start administering the drug when her mother’s symptoms worsen, hoping to avoid nursing home placement. How should the nurse respond?
- A. Affirm the decision to use the medication when the symptoms start to worsen.
- B. Explain that the drug should be used early in the disease process.
- C. Assess the patient’s current mental status before deciding to support the decision.
- D. Confirm that the daughter is aware of the progressive nature of the disease.
Correct Answer: B
Rationale: Rivastigmine is most effective early in Alzheimer’s (B) to slow symptom progression. Delaying until worsening (A) reduces benefits. Mental status assessment (C) informs but doesn’t guide timing. Discussing disease progression (D) is secondary to medication timing.
A client has a new prescription for zolpidem, a hypnotic. The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home. Which action should the nurse take?
- A. Explain that the client needs to allow for sleep time of at least two hours.
- B. Advise the client to take the medication with the noon meal.
- C. Encourage the client to wait until bedtime to take the medication.
- D. Remind the client to drink plenty of fluids when taking the medication.
Correct Answer: C
Rationale: Zolpidem, a sedative-hypnotic, should be taken at bedtime (C) to avoid daytime drowsiness and fall risk. Two hours of sleep (A) is insufficient for safe clearance. Taking with meals (B) reduces efficacy. Fluid intake (D) is unrelated to zolpidem’s administration.
A patient with hepatic encephalopathy is receiving lactulose. Which assessment provides the nurse with the best information to evaluate the patient’s therapeutic response to the drug?
- A. Stool color and character.
- B. Fingerstick glucose.
- C. Serum electrolytes and ammonia.
- D. Serum hepatic enzymes.
Correct Answer: C
Rationale: Lactulose reduces ammonia in hepatic encephalopathy by promoting its excretion. Monitoring serum ammonia and electrolytes (C) evaluates efficacy. Stool changes (A) are expected but not specific. Glucose (B) is unrelated. Hepatic enzymes (D) assess liver damage, not lactulose response.
An older adult with iron deficiency anemia is being discharged with a prescription for ferrous sulfate enteric-coated tablets. To promote the best absorption of the medication, what information should the nurse include in the discharge instructions?
- A. The best time to take the tablet is at bedtime.
- B. Crush the tablets and mix with pudding.
- C. Wait 2 hours after meals to take the tablet.
- D. Take the tablet with a daily multivitamin.
Correct Answer: C
Rationale: Ferrous sulfate is best absorbed on an empty stomach, 2 hours after meals (C). Bedtime dosing (A) isn’t specific to absorption. Crushing enteric-coated tablets (B) disrupts their protective coating. Multivitamins (D) may contain minerals that reduce iron absorption.