Nursing Elites

1. 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.

2. A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered?

• A. Intramuscularly in the deltoid muscle
• B. Subcutaneously in the gluteal muscle
• C. Subcutaneously in the outer aspect of the upper arm
• D. Intramuscularly in the anterolateral aspect of the thigh

Correct answer: C

Rationale: The MMR vaccine is best administered subcutaneously in the outer aspect of the upper arm. This route allows for proper absorption and efficacy of the vaccine while minimizing the risk of injury or discomfort to the child.

3. The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?

• A. Constipation
• B. Abdominal pain
• C. An episode of diarrhea
• D. Hematest-positive nasogastric tube drainage

Correct answer: C

Rationale: Loperamide hydrochloride (Imodium) is an antidiarrheal medication commonly used to manage episodes of diarrhea. It works by slowing down gut movement and reducing the frequency of bowel movements. Loperamide is not indicated for constipation, abdominal pain, or hematest-positive nasogastric tube drainage. It is specifically useful in acute and chronic diarrhea, such as in cases of inflammatory bowel disease, to help control symptoms and decrease fluid loss.

4. Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?

• A. Gastric atony
• B. Urinary strictures
• C. Neurogenic atony
• D. Gastroesophageal reflux

Correct answer: B

Rationale: Bethanechol chloride (Urecholine) should not be administered to clients with urinary strictures as it can contract the bladder and increase pressure within the urinary tract. In individuals with urinary strictures, this elevated pressure may lead to bladder rupture. Therefore, caution is advised when considering the use of Bethanechol chloride in clients with urinary strictures to prevent potential complications. Gastric atony, neurogenic atony, and gastroesophageal reflux are not contraindications for the administration of Bethanechol chloride for urinary retention.

5. A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus was previously well controlled with daily glyburide (DiaBeta). However, the fasting blood glucose level has recently been in the range of 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Prednisone
• B. Phenelzine (Nardil)
• C. Atenolol (Tenormin)
• D. Allopurinol (Zyloprim)

Correct answer: A

Rationale: Prednisone is known to reduce the effectiveness of oral hypoglycemic medications like glyburide and insulin, which can result in hyperglycemia. Therefore, the addition of prednisone to the client's regimen could have contributed to the elevated fasting blood glucose levels observed.

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