Nursing Elites

1. A client prescribed Warfarin is receiving discharge instructions from a nurse. Which of the following dietary instructions should the nurse include?

• A. Increase your intake of leafy green vegetables.
• B. Avoid foods high in vitamin K.
• C. Increase your intake of dairy products.
• D. Avoid foods high in iron.

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Vitamin K can interfere with the effectiveness of Warfarin, an anticoagulant medication. Foods high in vitamin K, such as leafy green vegetables, can reduce the medication's anticoagulant effect. Therefore, clients taking Warfarin should be advised to avoid or consume a consistent amount of foods high in vitamin K to maintain the medication's effectiveness. Choices A, C, and D are incorrect because increasing leafy green vegetables, dairy products, or avoiding foods high in iron are not directly related to the interaction with Warfarin.

2. A client with Hodgkin's disease is receiving Cyclophosphamide IV. Which medication should be administered concurrently to prevent an adverse effect of Cyclophosphamide?

• A. Uroprotectant agent, such as mesna
• B. Opioid, such as morphine
• C. Loop diuretic, such as furosemide
• D. H1 receptor antagonist, such as diphenhydramine

Correct answer: A

Rationale: Mesna, an uroprotectant agent, is administered with nitrogen mustard chemotherapy drugs like Cyclophosphamide to prevent hemorrhagic cystitis, a common adverse effect. Mesna works by binding to and inactivating the toxic metabolites of Cyclophosphamide in the bladder, thereby reducing the risk of bladder toxicity.

3. An older adult client has a new prescription for Digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for Digoxin toxicity?

• A. Phenytoin
• B. Verapamil
• C. Warfarin
• D. Aluminum hydroxide

Correct answer: B

Rationale: Verapamil, a calcium-channel blocker, can increase digoxin levels, leading to toxicity. When given together, the digoxin dosage may need adjustment, and the nurse should closely monitor the client's digoxin levels to prevent toxicity symptoms such as nausea, vomiting, visual disturbances, and arrhythmias. The other choices, Phenytoin, Warfarin, and Aluminum hydroxide, do not significantly interact with Digoxin to cause toxicity. Phenytoin may reduce Digoxin levels, while Warfarin and Aluminum hydroxide have minimal interactions with Digoxin.

4. A client with peptic ulcer disease is being taught about managing the condition. Which of the following statements indicates an understanding of the teaching?

• A. I should eat small, frequent meals that are low in fiber.
• B. I will limit my intake of caffeine-containing beverages.
• C. I should take NSAIDs to relieve my pain.
• D. I will drink milk before bedtime to decrease acid production.

Correct answer: B

Rationale: The correct answer is B: 'I will limit my intake of caffeine-containing beverages.' Limiting intake of caffeine-containing beverages is important for managing peptic ulcer disease as caffeine can stimulate gastric acid secretion, which may worsen the condition. It is advisable to choose decaffeinated beverages and avoid caffeinated drinks to help reduce the risk of aggravating the ulcer. Choices A, C, and D are incorrect. Choice A suggests eating small, frequent meals low in fiber, which is not ideal for managing peptic ulcer disease. Choice C of taking NSAIDs is contraindicated as NSAIDs can worsen peptic ulcers. Choice D of drinking milk before bedtime to decrease acid production is a common misconception; while milk may temporarily neutralize stomach acid, it can stimulate more acid production later, making the condition worse.

5. When teaching a client who has a prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Take the medication at bedtime.
• B. Monitor for a persistent cough.
• C. Expect to have increased appetite.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: The correct answer is B: 'Monitor for a persistent cough.' Lisinopril, an ACE inhibitor, can cause a persistent dry cough as a side effect. It is essential for the client to report this symptom to their healthcare provider for further evaluation and management. Choice A is incorrect because Lisinopril is typically taken in the morning. Choice C is incorrect as Lisinopril is not known to cause increased appetite. Choice D is also incorrect as Lisinopril can lead to increased potassium levels in the blood, so avoiding foods high in potassium is not necessary.

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