Nursing Elites

1. A client is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion?

• A. I signed up for a swimming class.
• B. I've been taking an antacid to help with indigestion.
• C. I've lost 2 pounds since my appointment 2 weeks ago.
• D. The naproxen is easier to take when I crush it and put it in applesauce.

Correct answer: B

Rationale: The client stating that they have been taking an antacid to help with indigestion while on naproxen requires further discussion. This statement suggests potential gastrointestinal distress or interactions between the medications. Antacids can affect the absorption of naproxen or lead to other complications. Therefore, the nurse should address this statement with the client to ensure safe and effective medication management. Choices A, C, and D do not raise immediate concerns related to the client's medication regimen and can be considered positive health behaviors or side effects of treatment that do not require immediate intervention.

2. A healthcare professional is reviewing the medical record of a client with a new prescription for Epoetin Alfa. Which of the following findings should the professional report to the provider?

• A. The client has a history of hypertension.
• B. The client has a hemoglobin level of 10 g/dL.
• C. The client has a history of chronic kidney disease.
• D. The client has a blood pressure of 140/90 mm Hg.

Correct answer: C

Rationale: The correct answer is C. Chronic kidney disease is a contraindication for the use of Epoetin Alfa because it can worsen hypertension, increase the risk of cardiovascular events, and lead to adverse outcomes. Epoetin Alfa is used to treat anemia by stimulating red blood cell production, but in the presence of chronic kidney disease, it can exacerbate hypertension and contribute to cardiovascular complications. Choices A, B, and D are not directly related to the contraindication of Epoetin Alfa in the presence of chronic kidney disease.

3. What is the primary action of warfarin as an anticoagulant?

• A. Prevents the formation of blood clots
• B. Dissolves existing blood clots
• C. Dilates coronary arteries
• D. Treats rhythm disturbances

Correct answer: A

Rationale: The correct answer is A: "Prevents the formation of blood clots." Warfarin acts as an anticoagulant by inhibiting the synthesis of certain clotting factors in the liver. This action reduces the blood's ability to clot, making it effective in preventing the formation of blood clots. Choice B is incorrect because warfarin does not dissolve existing blood clots; it prevents their formation. Choice C is incorrect because warfarin's primary action is not to dilate coronary arteries. Choice D is incorrect as warfarin is not used to treat rhythm disturbances, but rather to prevent clot formation.

4. A healthcare provider is assessing a client who is taking levothyroxine. The healthcare provider should recognize that which of the following findings is a manifestation of levothyroxine overdose?

• A. Insomnia
• B. Constipation
• C. Drowsiness
• D. Hypoactive deep-tendon reflexes

Correct answer: A

Rationale: Insomnia is a common symptom of levothyroxine overdose due to excessive stimulation of the central nervous system. Levothyroxine is a thyroid hormone replacement medication, and an overdose can lead to hyperthyroidism symptoms, including insomnia. Constipation and drowsiness are not typically associated with levothyroxine overdose. Hypoactive deep-tendon reflexes are more indicative of hypothyroidism rather than an overdose of levothyroxine.

5. In reviewing a client's health record, which condition would be a contraindication for using Propranolol to treat hypertension?

• A. Asthma
• B. Glaucoma
• C. Hypertension
• D. Tachycardia

Correct answer: A

Rationale: Propranolol is a nonselective beta-adrenergic blocker that blocks both beta1 and beta2 receptors. Blocking beta2 receptors in the lungs can lead to bronchoconstriction, making it unsuitable for clients with asthma. Therefore, asthma is a contraindication for taking Propranolol. Glaucoma, hypertension, and tachycardia are not contraindications for using Propranolol to treat hypertension.

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