Nursing Elites

1. A client has a new prescription for Warfarin. The nurse should identify that the concurrent use of which of the following medications increases the client's risk of bleeding?

• A. Vitamin K
• B. Calcium carbonate
• C. Acetaminophen
• D. Ranitidine

Correct answer: C

Rationale: The correct answer is Acetaminophen (Choice C). Acetaminophen, especially in high doses, can increase the risk of bleeding in clients taking Warfarin. It can potentiate the anticoagulant effect of Warfarin, leading to an increased risk of bleeding. Vitamin K (Choice A) is actually used to reverse the effects of Warfarin in case of over-anticoagulation, so it does not increase the risk of bleeding. Calcium carbonate (Choice B) and Ranitidine (Choice D) do not significantly interact with Warfarin to increase the risk of bleeding.

2. What is the correct medical term used to describe impaired blood flow in the coronary arteries?

• A. Myocardial infarction
• B. Angina pectoris
• C. Cerebrovascular accident
• D. Coronary heart disease

Correct answer: D

Rationale: The correct medical term for impaired blood flow in the coronary arteries is Coronary heart disease. This condition is characterized by a narrowing or blockage of the coronary arteries, leading to reduced blood flow to the heart muscle. Myocardial infarction (choice A) refers to a heart attack, which occurs when blood flow to a part of the heart is blocked. Angina pectoris (choice B) is chest pain or discomfort that occurs when the heart muscle doesn't receive enough oxygen-rich blood. Cerebrovascular accident (choice C) is the medical term for a stroke, which occurs when blood flow to a part of the brain is interrupted.

3. A client has a new prescription for atenolol. Which of the following findings should the nurse instruct the client to monitor for as an adverse effect of this medication?

• A. Tachycardia
• B. Hypoglycemia
• C. Bradycardia
• D. Hypertension

Correct answer: C

Rationale: Atenolol is a beta-blocker that works by slowing down the heart rate. An adverse effect of atenolol is bradycardia, characterized by a slower than normal heart rate. The nurse should instruct the client to monitor for signs of bradycardia, such as a slow heart rate, while taking atenolol. Therefore, the correct answer is to monitor for bradycardia. Tachycardia (Choice A) is not an expected adverse effect of atenolol as it actually reduces heart rate. Hypoglycemia (Choice B) is not a typical adverse effect of atenolol. Hypertension (Choice D) is not an adverse effect of atenolol, as atenolol is commonly used to manage hypertension.

4. A healthcare provider is reviewing the health history of a client who is starting therapy with tamoxifen. The healthcare provider should recognize that tamoxifen is contraindicated in which of the following clients?

• A. A client with a history of deep-vein thrombosis
• B. A client with a history of migraine headaches
• C. A client with a history of hypertension
• D. A client with a history of anemia

Correct answer: A

Rationale: Tamoxifen is contraindicated in clients with a history of thromboembolic events, such as deep-vein thrombosis, due to the increased risk of blood clots forming and leading to serious complications like pulmonary embolism. Clients with a history of deep-vein thrombosis are at a higher risk of recurrent thromboembolic events when taking tamoxifen, making it unsafe for such individuals. Choices B, C, and D are not contraindications for tamoxifen therapy, as migraine headaches, hypertension, and anemia do not directly interact with tamoxifen's mechanism of action or pose significant risks when used together.

5. A client is prescribed an IM dose of penicillin. The client reports developing a rash after taking penicillin 3 years ago. What should the nurse do?

• A. Administer the prescribed dose.
• B. Withhold the medication.
• C. Ask the provider to change the prescription to an oral form.
• D. Administer an oral antihistamine at the same time.

Correct answer: B

Rationale: The nurse should withhold the medication and inform the provider of the client's previous rash after taking penicillin. This history suggests a potential allergic reaction to penicillin, which can range from mild to severe anaphylaxis. Notifying the provider allows for an alternative antibiotic to be prescribed, considering the client's allergy to penicillin. It is crucial to avoid administering a medication that could potentially lead to a severe allergic reaction in the client. Administering the prescribed dose (Choice A) could be harmful due to the potential for an allergic reaction. Changing the prescription to an oral form (Choice C) does not address the underlying issue of a potential penicillin allergy. Administering an oral antihistamine (Choice D) without consulting the provider may not be sufficient to prevent a severe allergic reaction.

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