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 client has a new prescription for Alteplase. Which of the following actions should the nurse plan to take?

• A. Administer the medication within 4 hours of the onset of symptoms.
• B. Reconstitute the medication with sterile saline.
• C. Administer heparin concurrently with the Alteplase infusion.
• D. Monitor for changes in level of consciousness.

Correct answer: D

Rationale: Alteplase is a thrombolytic agent used to dissolve blood clots. Patients receiving Alteplase are at risk for bleeding complications, including intracranial bleeding. Monitoring for changes in the level of consciousness is crucial as it can indicate early signs of bleeding, such as increased intracranial pressure. This rapid assessment allows for timely intervention and prevention of further complications. Choices A, B, and C are incorrect. Administering Alteplase within 4 hours of symptom onset is related to the time-sensitive nature of thrombolytic therapy for conditions like acute myocardial infarction or ischemic stroke. Reconstituting Alteplase with sterile saline is a correct step in preparing the medication for administration. Administering heparin concurrently with Alteplase is generally avoided due to the increased risk of bleeding.

3. A client is being taught by a nurse about long-term use of oral prednisone for chronic asthma. The nurse should instruct the client to monitor for which of the following adverse effects?

• A. Weight Gain
• B. Nervousness
• C. Bradycardia
• D. Constipation

Correct answer: A

Rationale: Weight gain is a common adverse effect of long-term prednisone use. Prednisone, a corticosteroid medication, can cause fluid retention and increased appetite, leading to weight gain. Nervousness (choice B) is more commonly associated with stimulant medications or excessive caffeine intake. Bradycardia (choice C) refers to a slow heart rate and is not a typical adverse effect of prednisone. Constipation (choice D) is not a common side effect of prednisone; in fact, prednisone is more likely to cause gastrointestinal issues such as increased appetite and weight gain.

4. Which drug is the antidote for Alprazolam?

• A. Physostigmine
• B. Protamine sulfate
• C. Flumazenil
• D. Acetylcysteine

Correct answer: C

Rationale: Flumazenil is the specific antidote used to reverse the effects of Alprazolam. Alprazolam is a benzodiazepine, and Flumazenil is a benzodiazepine receptor antagonist that works by competitively inhibiting the actions of benzodiazepines at the receptor site, effectively reversing their sedative and other effects. Physostigmine is not used as an antidote for benzodiazepine overdose and can have significant side effects. Protamine sulfate is used to reverse the effects of heparin, not benzodiazepines like Alprazolam. Acetylcysteine is used as an antidote for acetaminophen overdose, not benzodiazepines like Alprazolam.

5. While assessing a client taking Amiodarone to treat Atrial Fibrillation, which of the following findings is indicative of Amiodarone toxicity?

• A. Light yellow urine
• B. Report of tinnitus
• C. Productive cough
• D. Blue-gray skin discoloration

Correct answer: C

Rationale: Productive cough can indicate pulmonary toxicity, which is a known adverse effect of Amiodarone. Clients on Amiodarone should be monitored for signs of pulmonary toxicity such as cough, dyspnea, and chest pain. This is important to detect early and prevent serious complications. The other options are not typically associated with Amiodarone toxicity. Light yellow urine is not a common sign, tinnitus is more related to ear problems, and blue-gray skin discoloration is not a recognized symptom of Amiodarone toxicity.

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