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A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?
- A. Apply the patch to a different site each time.
- B. Change the patch every 72 hours.
- C. Avoid using additional heating pads over the patch.
- D. Remove the patch before showering.
Correct Answer: B
Rationale: The correct answer is B: Change the patch every 72 hours. Fentanyl patches are typically designed to be worn for 72 hours before being replaced to maintain consistent pain relief. Changing the patch on time helps prevent withdrawal symptoms and ensures the effectiveness of the medication.
A: Applying the patch to a different site each time is important to prevent skin irritation but is not the most crucial instruction.
C: Avoiding heating pads over the patch is important to prevent overheating and excessive absorption of the medication, but changing the patch timely is more critical.
D: Removing the patch before showering is not necessary as fentanyl patches are designed to be water-resistant.
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A client is admitted with a diagnosis of acute pancreatitis. Which laboratory value should the nurse monitor closely?
- A. Serum amylase.
- B. Serum sodium.
- C. Serum calcium.
- D. Serum potassium.
Correct Answer: A
Rationale: The correct answer is A: Serum amylase. In acute pancreatitis, there is inflammation of the pancreas leading to elevated serum amylase levels. Amylase is an enzyme produced by the pancreas, and increased levels indicate pancreatic injury. Monitoring serum amylase helps in diagnosing and assessing the severity of pancreatitis.
Choice B: Serum sodium, and Choice D: Serum potassium may be affected in pancreatitis due to fluid shifts, but they are not specific markers for pancreatitis.
Choice C: Serum calcium may also be affected in pancreatitis, but monitoring serum calcium is not as crucial as monitoring serum amylase for diagnosing and managing acute pancreatitis.
An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report?
- A. Look at last quarter's hemoglobin and hematocrit to assess for dehydration.
- B. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage.
- C. Expect to find an increase in today's APTT compared to last quarter's due to bleeding.
- D. Determine if there is a decrease in serum potassium due to renal compromise.
Correct Answer: B
Rationale: The correct answer is B. The nurse should look for an increase in today's LDH compared to the previous one to assess for possible liver damage. Acetaminophen overdose can lead to liver toxicity, which can be indicated by elevated LDH levels. LDH is an enzyme released during liver damage. Checking for LDH levels can help assess the impact of increased acetaminophen doses on the liver.
Choices A, C, and D are incorrect:
A: Looking at hemoglobin and hematocrit is not directly related to acetaminophen use for joint pain. It does not provide information about liver damage.
C: APTT measures blood clotting time and is not directly affected by acetaminophen use for joint pain. It does not provide information about liver damage.
D: Serum potassium levels are not typically affected by acetaminophen use for joint pain. It does not provide information about liver damage.
A client with heart failure is receiving intravenous furosemide (Lasix). Which assessment finding indicates that the medication is having the desired effect?
- A. Decreased peripheral edema.
- B. Elevated blood pressure.
- C. Increased heart rate.
- D. Decreased urine output.
Correct Answer: A
Rationale: The correct answer is A: Decreased peripheral edema. Furosemide is a diuretic that helps to remove excess fluid from the body, which can reduce peripheral edema in patients with heart failure. This indicates that the medication is effectively reducing fluid overload in the body. Elevated blood pressure (choice B) would not be an expected outcome of furosemide use. Increased heart rate (choice C) is not a direct effect of furosemide and can indicate worsening heart failure. Decreased urine output (choice D) would be an adverse effect of furosemide and would indicate the medication is not working as intended.
A patient with schizophrenia is prescribed olanzapine. What is an important side effect for the healthcare provider to monitor?
- A. Hypertension
- B. Weight gain
- C. Hypoglycemia
- D. Bradycardia
Correct Answer: B
Rationale: The correct answer is B: Weight gain. Olanzapine is known to cause metabolic side effects, including weight gain. This is important to monitor as it can lead to various health issues such as diabetes and cardiovascular problems. Hypertension (A), hypoglycemia (C), and bradycardia (D) are not commonly associated with olanzapine use, making them less likely side effects to monitor in this case.
What is the primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT)?
- A. No need for regular INR monitoring
- B. Lower risk of bleeding
- C. Fewer dietary restrictions
- D. Longer half-life
Correct Answer: A
Rationale: The primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of DVT is the absence of regular INR monitoring required with rivaroxaban. This is because rivaroxaban is a direct oral anticoagulant with more predictable pharmacokinetics, eliminating the need for monitoring. Regular INR monitoring is necessary with warfarin to ensure the drug is within the therapeutic range, which can be burdensome for patients and healthcare providers. The other choices are incorrect as they do not directly address the primary advantage of rivaroxaban over warfarin for this specific patient population.