Nursing Elites

1. A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?

• A. The client is experiencing vision and hearing loss.
• B. The client has an erection lasting longer than 4 hours.
• C. The client is complaining of nasal congestion.
• D. The client is complaining of feeling flushed.

Correct answer: A

Rationale: The correct answer is A. If a client prescribed sildenafil for pulmonary hypertension experiences vision and/or hearing loss or an erection lasting more than 4 hours, the practical nurse should instruct the client to discontinue the medication immediately and notify the health care provider. These symptoms could indicate serious side effects that require prompt medical attention to prevent complications. Choices B, C, and D are incorrect because an erection lasting more than 2 hours (not 4 hours as stated in choice B) is a critical adverse effect that warrants immediate medical attention. Nasal congestion (choice C) and feeling flushed (choice D) are common side effects of sildenafil and typically do not necessitate immediate discontinuation of the medication or emergency intervention.

2. A 43-year-old female client who has had a thyroidectomy due to Grave's disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the healthcare provider?

• A. Tinnitus and dizziness
• B. Tachycardia and chest pain
• C. Dry skin and intolerance to cold
• D. Weight gain and increased appetite

Correct answer: B

Rationale: The correct answer is B: Tachycardia and chest pain. Signs and symptoms of thyroid hormone toxicity, especially in cases of excessive dosage, include tachycardia (rapid heart rate) and chest pain. These symptoms are consistent with hyperthyroidism, where the body is receiving an excessive amount of thyroid hormone. It is crucial to report these symptoms promptly to the healthcare provider to adjust the medication dosage and prevent potential complications. Choices A, C, and D are not indicative of thyroid hormone toxicity. Tinnitus and dizziness (Choice A) are not typical symptoms of thyroid hormone toxicity. Dry skin and intolerance to cold (Choice C) are more common in hypothyroidism, while weight gain and increased appetite (Choice D) are associated with hypothyroidism as well, not thyroid hormone toxicity.

3. A client is taking levodopa-carbidopa for Parkinson's disease. The nurse should include which instruction when educating the client about this medication?

• A. Increase fluid intake to prevent dehydration.
• B. Take medication with food to improve absorption.
• C. Take medication at bedtime to avoid daytime drowsiness.
• D. It can cause nausea and dizziness.

Correct answer: A

Rationale: The correct instruction for a client taking levodopa-carbidopa for Parkinson's disease is to increase fluid intake to prevent dehydration. Levodopa-carbidopa should be taken with food to reduce gastrointestinal upset and improve absorption. Taking medication at bedtime is not necessary to avoid daytime drowsiness. It is crucial to prevent dehydration due to the medication's side effects. Choice B is incorrect because the medication should be taken with food, not at bedtime. Choice C is incorrect as taking the medication with food, rather than on an empty stomach, aids in absorption and reduces gastrointestinal side effects. Choice D is incorrect as it states the side effects of the medication rather than providing specific instructions on its administration.

4. A client with diabetes mellitus type 2 is prescribed canagliflozin. The nurse should include which instruction in the client's teaching plan?

• A. Report any signs of urinary tract infection.
• B. Take this medication with meals.
• C. Avoid alcohol while taking this medication.
• D. Avoid taking this medication with grapefruit juice.

Correct answer: A

Rationale: The correct instruction to include in the client's teaching plan is to report any signs of urinary tract infection. Canagliflozin, a medication used in diabetes mellitus type 2, can increase the risk of urinary tract infections. Instructing the client to report any signs of infection is crucial for early intervention and management. Choices B, C, and D are incorrect because there is no specific requirement to take canagliflozin with meals, avoid alcohol, or restrict grapefruit juice consumption while on this medication.

5. A client with a diagnosis of generalized anxiety disorder is prescribed fluvoxamine. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Insomnia
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Fluvoxamine is known to cause drowsiness as a potential side effect. Patients should be advised to avoid activities like driving that require alertness until they understand how the medication affects them. Dry mouth, insomnia, and headache are potential side effects of other medications used for anxiety disorders but are not typically associated with fluvoxamine.

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