Nursing Elites

1. 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.

2. A client has a new prescription for Furosemide. Which of the following instructions should be included?

• A. Take this medication at bedtime.
• B. Avoid eating foods high in potassium.
• C. Change positions slowly.
• D. Take this medication with meals.

Correct answer: C

Rationale: Furosemide is a diuretic that can lead to orthostatic hypotension, causing dizziness and falls. Instructing the client to change positions slowly helps prevent these adverse effects by allowing the body to adjust to postural changes gradually, reducing the risk of significant blood pressure drops upon standing up quickly.

3. When providing discharge instructions to a client with a new prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Avoid salt substitutes.
• B. Take this medication at bedtime.
• C. Increase your intake of potassium-rich foods.
• D. Take this medication with food.

Correct answer: A

Rationale: The correct answer is to instruct the client to avoid salt substitutes. Lisinopril, an ACE inhibitor, can lead to hyperkalemia, so it is essential to avoid salt substitutes containing potassium, which can further increase potassium levels in the body. This instruction aims to prevent potential adverse effects and ensure the client's safety while taking Lisinopril. Choices B, C, and D are incorrect because Lisinopril is typically taken once a day in the morning, it can lead to hyperkalemia (so increasing potassium-rich foods is not advised), and it can be taken with or without food.

4. A client is taking Paroxetine to treat PTSD and reports teeth grinding at night. Which interventions should the nurse implement to manage Bruxism? (Select all that apply.)

• A. Concurrent administration of buspirone.
• B. Administration of a different SSRI.
• C. Use of a mouth guard.
• D. Changing to a different class of antidepressant medication.

Correct answer: A

Rationale: The correct interventions to manage Bruxism associated with Paroxetine use include A: Concurrent administration of buspirone. Buspirone can help alleviate the side effect of Bruxism. Additionally, C: Use of a mouth guard is recommended to prevent oral damage from teeth grinding. B: Administration of a different SSRI is not necessary since the issue is specific to Paroxetine. D: Changing to a different class of antidepressant medication may be considered in severe cases, but the initial step should be to add buspirone to address the Bruxism caused by Paroxetine.

5. Why has an ACE inhibitor been prescribed following an MI?

• A. “This medication will lower your potassium level.”
• B. “ACE inhibitors have been found to reduce mortality following MI.”
• C. “ACE inhibitors are always prescribed with a beta blocker and calcium channel blocker following an MI.”
• D. “This medication will treat your hypotension.”

Correct answer: B

Rationale: Following a myocardial infarction (MI), ACE inhibitors are commonly prescribed due to their proven benefit in reducing mortality and improving outcomes post-MI. These medications help by decreasing the workload of the heart, preventing remodeling of the heart chambers, and improving survival rates. While ACE inhibitors may have effects on potassium levels, the primary reason for their prescription post-MI is their mortality-reducing properties.

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