Nursing Elites

1. 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. The estrogenic effects of tamoxifen can further increase the risk of thromboembolic events, making it unsafe for individuals with a history of deep-vein thrombosis. Choice B (migraine headaches), Choice C (hypertension), and Choice D (anemia) are not contraindications for tamoxifen therapy. Migraine headaches, hypertension, and anemia do not pose the same risk of adverse effects related to blood clot formation as deep-vein thrombosis does.

2. When educating a client who has a prescription for Levothyroxine, which instruction should the nurse include?

• A. Take this medication on an empty stomach.
• B. Take this medication with food.
• C. Take this medication at bedtime.
• D. Take this medication with antacids.

Correct answer: A

Rationale: The correct instruction for taking Levothyroxine is on an empty stomach. This helps to enhance the absorption and effectiveness of the medication. Consuming it with food or antacids can impede its absorption, leading to decreased efficacy.

3. 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.

4. A client with Peptic Ulcer Disease who is taking Sucralfate PO has a new prescription for phenytoin to control seizures. Which of the following instructions should the nurse include?

• A. Take an antacid with the sucralfate.
• B. Take sucralfate with a glass of milk.
• C. Allow a 2-hour interval between these medications.
• D. Chew the sucralfate thoroughly before swallowing.

Correct answer: C

Rationale: Sucralfate can interfere with the absorption of phenytoin. To prevent this interaction, the client should allow a 2-hour interval between taking sucralfate and phenytoin. This interval helps ensure that each medication is absorbed effectively without affecting the other's absorption. Choices A, B, and D are incorrect because taking an antacid with sucralfate, taking sucralfate with a glass of milk, or chewing sucralfate thoroughly before swallowing are not necessary or recommended instructions to prevent the interaction between sucralfate and phenytoin.

5. A nurse is teaching a client who has a new prescription for Spironolactone. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, so the nurse should monitor the client for hyperkalemia, which can cause muscle weakness and cardiac dysrhythmias.

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