Nursing Elites

1. A client has a new prescription for Amlodipine. Which of the following instructions should the nurse include during discharge teaching?

• A. Take the medication at bedtime.
• B. Avoid drinking grapefruit juice.
• C. Increase your intake of high-sodium foods.
• D. Expect a dry cough.

Correct answer: B

Rationale: The correct instruction for the nurse to include during discharge teaching is to advise the client to avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of amlodipine, a calcium channel blocker, leading to increased drug levels in the blood. This can result in potentiated side effects and potential toxicity. Option A is incorrect as amlodipine is usually taken once daily, not specifically at bedtime. Option C is incorrect because high-sodium foods are generally discouraged in individuals with hypertension. Option D is incorrect as a dry cough is not an expected side effect of amlodipine.

2. A client has a new prescription for Albuterol and Beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?

• A. Take the albuterol at the same time each day.
• B. Administer the albuterol inhaler prior to using the beclomethasone inhaler.
• C. Use beclomethasone if experiencing an acute episode.
• D. Avoid shaking the beclomethasone before use.

Correct answer: B

Rationale: When a client is prescribed an inhaled beta2-agonist, such as albuterol, and an inhaled glucocorticoid, such as beclomethasone, for asthma control, the beta2-agonist should be administered first. This sequence is important because the beta2-agonist promotes bronchodilation, which enhances the absorption and effectiveness of the glucocorticoid. Instructing the client to administer the albuterol inhaler before using the beclomethasone inhaler ensures optimal therapeutic benefit. Therefore, option B is the correct choice. Option A is incorrect because the timing of albuterol administration may vary based on the prescribed regimen. Option C is incorrect because beclomethasone is a controller medication, not a rescue medication, and should not be used during acute episodes. Option D is incorrect because beclomethasone should be shaken before use to ensure proper dispersion of the medication.

3. A client has been prescribed a new oral hypoglycemic agent for diabetes. Which of the following statements by the client indicates a need for further teaching?

• A. I will take this medication with my evening snack.
• B. I will monitor my blood sugar levels before each meal.
• C. I will take this medication as soon as I wake up.
• D. I will follow my exercise plan as usual.

Correct answer: A

Rationale: Taking an oral hypoglycemic agent with an evening snack may lead to hypoglycemia during the night. It is important to follow the prescribed timing for medication administration to maintain blood sugar levels within the target range. The medication is usually taken before meals to help control postprandial blood glucose levels effectively. Choice B is correct as monitoring blood sugar levels before each meal is a good practice. Choice C is incorrect as taking the medication upon waking up may align with certain oral hypoglycemic agents' dosing schedules. Choice D is also correct as regular exercise is an important part of managing diabetes.

4. The healthcare professional is preparing to administer atenolol (Tenormin) to a client with angina. Which vital sign would cause the healthcare professional to question administering this drug?

• A. Respirations 12 breaths per minute
• B. Pulse 52 beats per minute
• C. Blood pressure 134/72
• D. Oxygen saturation 95%

Correct answer: B

Rationale: Atenolol is a beta-blocker medication that can lower heart rate. A pulse of 52 beats per minute is relatively low and administering atenolol could further decrease the heart rate, potentially leading to bradycardia. Monitoring the pulse rate and holding the medication if the pulse is below the prescribed parameters is crucial to prevent adverse effects such as bradycardia and hypotension.

5. A healthcare provider is reviewing the health history of a client who is starting therapy with tamoxifen. The healthcare provider should recognize that tamoxifen is contraindicated in which of the following clients?

• A. A client with a history of deep-vein thrombosis
• B. A client with a history of migraine headaches
• C. A client with a history of hypertension
• D. A client with a history of anemia

Correct answer: A

Rationale: Tamoxifen is contraindicated in clients with a history of thromboembolic events, such as deep-vein thrombosis, due to the increased risk of blood clots forming and leading to serious complications like pulmonary embolism. Clients with a history of deep-vein thrombosis are at a higher risk of recurrent thromboembolic events when taking tamoxifen, making it unsafe for such individuals. Choices B, C, and D are not contraindications for tamoxifen therapy, as migraine headaches, hypertension, and anemia do not directly interact with tamoxifen's mechanism of action or pose significant risks when used together.

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