Nursing Elites

1. A client is being monitored while receiving bethanechol chloride (Urecholine) for urinary retention. Which of the following indicates a therapeutic effect of this medication?

• A. Increased heart rate
• B. Increased peristalsis
• C. Passage of flatus
• D. Urinary output of 50 mL per hour

Correct answer: D

Rationale: Bethanechol chloride (Urecholine) is administered to stimulate the bladder and treat urinary retention. The therapeutic effect is indicated by an increased urinary output, as it demonstrates the medication's ability to prompt the bladder to empty. Increased heart rate and passage of flatus are unrelated to the therapeutic effects of bethanechol. Although bethanechol can increase peristalsis, the primary therapeutic goal is to address urinary retention.

2. Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:

• A. Increase DNA and RNA synthesis.
• B. Promote the biosynthesis of nucleic acids.
• C. Increase estrogen concentration and estrogen response.
• D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Correct answer: D

Rationale: The primary action of tamoxifen, an antineoplastic medication used in metastatic breast carcinoma, is to compete with estradiol for binding to estrogen receptors in tissues with high receptor concentrations. By doing so, tamoxifen reduces DNA synthesis and estrogen response, leading to its therapeutic effect in inhibiting the growth of estrogen-sensitive breast cancer cells.

3. A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client. The nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary?

• A. I can take aspirin or my antihistamine if I need it.
• B. I need to take the medication every day at the same time.
• C. I need to avoid coffee, tea, cola, and chocolate in my diet.
• D. If I gain more than 5 pounds a week, I will call my doctor.

Correct answer: A

Rationale: Aspirin and other over-the-counter medications should not be taken without consulting the health care provider (HCP). The client needs to take the medication at the same time every day and avoid caffeine-containing foods and fluids to prevent steroid-ulcer development.

4. The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following?

• A. I can skip a dose once a week.
• B. I need to change my position slowly.
• C. I take the pill after breakfast each day.
• D. If I get a bad headache, I should call my doctor immediately.

Correct answer: A

Rationale: Lisinopril should be taken daily as prescribed and not skipped. Skipping doses can lead to ineffective treatment.

5. Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with prednisone?

• A. An additional dose of prednisone daily
• B. A decreased amount of daily Humulin NPH insulin
• C. An increased amount of daily Humulin NPH insulin
• D. The addition of an oral hypoglycemic medication daily

Correct answer: C

Rationale: When prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily, the nurse should anticipate an increased amount of daily Humulin NPH insulin. Prednisone, a glucocorticoid, can elevate blood glucose levels, requiring an increase in insulin dosage to maintain optimal blood sugar control.

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