Nursing Elites

1. A healthcare provider is reviewing the health care record of a client who is asking about conjugated equine estrogens. The healthcare provider should inform the client this medication is contraindicated in which of the following conditions?

• A. Atrophic vaginitis
• B. Dysfunctional uterine bleeding
• C. Osteoporosis
• D. Thrombophlebitis

Correct answer: D

Rationale: Conjugated equine estrogens are contraindicated in individuals with a history of thrombophlebitis due to the increased risk of thrombotic events associated with estrogen use. Thrombophlebitis is a condition characterized by inflammation and blood clot formation in the veins, and estrogen therapy can exacerbate this condition, leading to serious complications such as deep vein thrombosis. Therefore, caution is advised when considering estrogen therapy in clients with a history of thrombophlebitis to prevent adverse outcomes. Choices A, B, and C are not contraindications for conjugated equine estrogens. Atrophic vaginitis and dysfunctional uterine bleeding may actually be conditions for which estrogen therapy is indicated. Osteoporosis can also be managed with estrogen therapy in certain cases to help prevent bone density loss.

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. When educating a client starting a new prescription for simvastatin, which instruction should the nurse provide?

• A. Take the medication in the morning.
• B. Report any muscle pain immediately.
• C. Avoid taking the medication with grapefruit juice.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct instruction for a client starting simvastatin is to report any muscle pain immediately because it could be indicative of rhabdomyolysis, a serious side effect of the medication. This prompt reporting can help prevent further complications and ensure timely medical intervention. Choice A is incorrect because simvastatin can be taken at any time of the day. Choice C is generally true for many medications, but there is no specific interaction between grapefruit juice and simvastatin. Choice D is also incorrect as there is no specific recommendation to take simvastatin at bedtime.

4. A client has a new prescription for allopurinol. Which of the following instructions should the nurse include?

• A. Drink 2 liters of water daily.
• B. Avoid taking the medication on an empty stomach.
• C. Limit vitamin C intake while taking this medication.
• D. Take an iron supplement while on this medication.

Correct answer: A

Rationale: The correct instruction for a client prescribed allopurinol is to drink 2 liters of water daily. This recommendation aims to reduce the risk of kidney stones, a potential side effect associated with allopurinol use. Adequate hydration helps prevent the formation of uric acid crystals in the kidneys, which can lead to kidney stones. Therefore, encouraging increased water intake is essential in the management of clients taking allopurinol.

5. A client with tobacco use disorder is being educated about Nicotine replacement therapy. Which statement by the client indicates an understanding of the teaching?

• A. I should avoid eating right before chewing a piece of nicotine gum.
• B. I will need to stop using the nicotine gum after 1 year.
• C. I know that nicotine gum is a safe alternative to smoking during pregnancy.
• D. I must chew the nicotine gum quickly for about 15 minutes.

Correct answer: A

Rationale: The correct answer is A. To maximize the effectiveness of nicotine gum, the client should avoid eating or drinking 15 minutes before and while using it. This helps ensure proper absorption of nicotine through the oral mucosa. Choice B is incorrect because the duration of nicotine gum use can vary depending on the individual's needs and progress. Choice C is incorrect as nicotine gum should be used during pregnancy only under healthcare provider guidance. Choice D is incorrect because nicotine gum should be chewed slowly until a tingling sensation is felt, then parked between the cheek and gum until the tingling stops.

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