Nursing Elites

1. A client with angina asks about obtaining a prescription for sildenafil to treat erectile dysfunction. Which of the following medications is contraindicated with Sildenafil?

• A. Aspirin
• B. Isosorbide
• C. Clopidogrel
• D. Atorvastatin

Correct answer: B

Rationale: Isosorbide is an organic nitrate used to manage angina. Concurrent use of sildenafil with organic nitrates, like isosorbide, is contraindicated due to the risk of fatal hypotension. It is essential for clients to avoid taking nitrate medications within 24 hours of using isosorbide to prevent serious complications.

2. When administering a Serotonin Antagonist, what is important to monitor for?

• A. Intake and output
• B. Mental status changes
• C. Respiratory rate
• D. Anorexia

Correct answer: B

Rationale: When administering a Serotonin Antagonist, monitoring mental status changes is crucial. Serotonin Antagonists can affect neurological function, potentially leading to alterations in mental status. It is essential to assess for any changes in behavior, mood, or cognition to ensure patient safety and prompt intervention if needed.

3. A client with deep vein thrombosis has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

• A. Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.
• B. I will call the provider to get a prescription for discontinuing the IV heparin today.
• C. Both heparin and warfarin work together to dissolve the clots.
• D. The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay.

Correct answer: A

Rationale: The correct answer is A because warfarin takes several days to reach a therapeutic level and exert its full anticoagulant effect. During this time, the IV heparin is continued to prevent clotting until the warfarin is effective. Both medications are used together temporarily for this reason. Discontinuing heparin prematurely can increase the risk of clot formation. Therefore, the nurse should explain to the client that the IV heparin will be continued until the warfarin reaches a therapeutic level.

4. A client with migraine headaches is starting prophylaxis therapy with Propranolol. Which finding in the client's history should the nurse report to the provider?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with first-degree heart block due to its negative inotropic and chronotropic effects. The nurse should report this finding to the provider to consider an alternative therapy to prevent potential worsening of cardiac conduction abnormalities. Choices A, B, and C are not directly contraindications to Propranolol therapy for migraine headaches and do not pose immediate risks that would require reporting to the provider.

5. A healthcare professional is reviewing a client's health record and notes that the client experiences permanent extrapyramidal effects caused by a previous medication. The healthcare professional should recognize that the medication affected which of the following systems in the client?

• A. Cardiovascular
• B. Immune
• C. Central nervous
• D. Gastrointestinal

Correct answer: C

Rationale: The correct answer is C: Central nervous. Extrapyramidal effects are movement disorders caused by certain medications affecting the central nervous system. These effects can include symptoms like tremors, rigidity, and bradykinesia. Medications like typical antipsychotics induce extrapyramidal effects by interfering with dopamine transmission in the central nervous system. Choices A, B, and D are incorrect as extrapyramidal effects are specifically related to the central nervous system and not the cardiovascular, immune, or gastrointestinal systems.

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