Nursing Elites

1. A client with a history of deep vein thrombosis is prescribed rivaroxaban. The nurse should monitor for which potential adverse effect?

• A. Increased risk of bleeding
• B. Decreased risk of bleeding
• C. Increased risk of infection
• D. Decreased risk of infection

Correct answer: A

Rationale: When a client with a history of deep vein thrombosis is prescribed rivaroxaban, the nurse should monitor for signs of bleeding as rivaroxaban increases the risk of bleeding. Common adverse effects of rivaroxaban include bleeding events, such as easy bruising, prolonged bleeding from cuts, or blood in the urine or stool. It is crucial for the nurse to assess for these signs to prevent complications and ensure the client's safety. Choices B, C, and D are incorrect because rivaroxaban does not decrease the risk of bleeding, increase the risk of infection, or decrease the risk of infection. Monitoring for bleeding is essential due to the anticoagulant properties of rivaroxaban.

2. A client with a history of deep vein thrombosis is prescribed apixaban. The nurse should monitor for which potential adverse effect?

• A. Increased risk of bleeding
• B. Decreased risk of bleeding
• C. Increased risk of infection
• D. Decreased risk of infection

Correct answer: A

Rationale: The correct answer is A: Increased risk of bleeding. Apixaban is an anticoagulant medication that works by preventing blood clots. While this is beneficial for individuals with a history of deep vein thrombosis, it also increases the risk of bleeding. Therefore, the nurse should monitor the client for signs of bleeding, such as easy bruising, prolonged bleeding from cuts, or blood in the urine or stool. Monitoring for bleeding is crucial to ensure the client's safety and to take appropriate actions if necessary. Choices B, C, and D are incorrect because apixaban does not decrease the risk of bleeding, increase the risk of infection, or decrease the risk of infection. The primary concern when administering apixaban is monitoring for potential bleeding complications.

3. A client receiving enalapril reports a persistent dry cough. The nurse should explain that this side effect is related to which medication action?

• A. It reduces the production of angiotensin II.
• B. It increases the production of angiotensin II.
• C. It causes increased production of bradykinin.
• D. It increases the production of aldosterone.

Correct answer: C

Rationale: The correct answer is C. Enalapril, an ACE inhibitor, inhibits the conversion of angiotensin I to angiotensin II, leading to increased levels of bradykinin. The accumulation of bradykinin is responsible for the persistent dry cough associated with ACE inhibitors like enalapril. Choices A, B, and D are incorrect because enalapril does not directly affect the production of angiotensin II or aldosterone. Instead, it primarily impacts the renin-angiotensin-aldosterone system by inhibiting the conversion of angiotensin I to angiotensin II, leading to bradykinin accumulation.

4. A client with rheumatoid arthritis is prescribed methotrexate. The nurse should include which instruction in the client's teaching plan?

• A. Avoid alcohol while taking this medication.
• B. Take this medication with food to decrease gastrointestinal upset.
• C. Avoid sunlight while taking this medication.
• D. Report any signs of infection to the healthcare provider.

Correct answer: C

Rationale: The correct instruction for a client prescribed methotrexate is to avoid sunlight while taking this medication. Methotrexate can increase sensitivity to sunlight, leading to skin reactions. It is essential for clients to limit sun exposure and use protective measures like sunscreen and clothing coverage to prevent adverse effects. Choices A, B, and D are incorrect because avoiding alcohol, taking with food, and reporting signs of infection are not specific instructions related to methotrexate therapy.

5. A client with a diagnosis of bipolar disorder is prescribed topiramate. The nurse should monitor for which potential adverse effect?

• A. Cognitive impairment
• B. Weight gain
• C. Liver toxicity
• D. Weight loss

Correct answer: A

Rationale: Correct. Topiramate is associated with cognitive impairment as an adverse effect. It is important for the nurse to monitor the client's cognitive function while on this medication to assess for any signs of cognitive decline or impairment. Choice B, weight gain, is incorrect as topiramate is actually associated with weight loss rather than weight gain. Choice C, liver toxicity, is also incorrect as topiramate is not known to cause liver toxicity. Choice D, weight loss, is not the correct answer as topiramate is not associated with weight gain.

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