Nursing Elites

1. A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?

• A. Monitor for renal failure.
• B. Monitor psychosocial status.
• C. Monitor for signs of bleeding.
• D. Have heparin sodium available.

Correct answer: C

Rationale: The priority nursing intervention for a client receiving tissue plasminogen activator (alteplase) for an acute myocardial infarction is to monitor for signs of bleeding. Alteplase is a thrombolytic medication that can lead to hemorrhage as a complication. Therefore, closely monitoring the client for any signs of bleeding is essential to promptly address and manage this potential adverse effect.

2. Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?

• A. Neuralgia
• B. Insomnia
• C. Use of nitroglycerin
• D. Use of multivitamins

Correct answer: C

Rationale: The correct answer is C. Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide and is contraindicated with the concurrent use of organic nitrates and nitroglycerin. Using nitroglycerin together with Viagra can lead to severe hypotension and cardiovascular collapse, making it unsafe to combine both medications.

3. Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?

• A. Decreased urinary output
• B. Decreased blood pressure
• C. Decreased peripheral edema
• D. Decreased blood glucose level

Correct answer: A

Rationale: Desmopressin promotes renal conservation of water by increasing the permeability of kidney collecting ducts to water, resulting in decreased urinary output. Therefore, the therapeutic response expected after administering desmopressin for diabetes insipidus is a reduction in urinary output.

4. A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question?

• A. Cyclobenzaprine (Flexeril)
• B. Alendronate (Fosamax)
• C. Allopurinol (Zyloprim)
• D. Prednisone

Correct answer: D

Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, reducing the body's ability to withstand stress. During surgery, the dosage may need to be adjusted due to its impact on the body's stress response. Choices A, B, and C are not typically contraindicated before surgery and do not have the same potential impact on the body's stress response.

5. A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the client indicates a need for further teaching?

• A. I will avoid foods high in vitamin K.
• B. I will take the medication at the same time each day.
• C. I will use an electric razor to shave.
• D. I will take aspirin if I have a headache.

Correct answer: D

Rationale: Clients taking warfarin (Coumadin) should avoid aspirin unless prescribed by their healthcare provider, as it can increase the risk of bleeding. The other statements are correct and do not indicate a need for further teaching. Taking aspirin along with warfarin can potentiate the anticoagulant effects of warfarin, leading to an increased risk of bleeding complications.

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