Nursing Elites

1. A client with breast cancer is being taught about Tamoxifen. Which of the following adverse effects of tamoxifen should the client be informed about?

• A. Irregular heart rhythm
• B. Abnormal uterine bleeding
• C. Yellowing of the sclera or dark-colored urine
• D. Difficulty swallowing

Correct answer: B

Rationale: Abnormal uterine bleeding is a known adverse effect of tamoxifen. It is important to educate the client about this side effect as those taking tamoxifen are at an increased risk for endometrial cancer. Any abnormal uterine bleeding should be promptly reported and evaluated by healthcare providers to ensure timely management and monitoring. The other options, such as irregular heart rhythm, yellowing of the sclera or dark-colored urine, and difficulty swallowing, are not typically associated with tamoxifen use and are not commonly reported adverse effects. Therefore, they are not the priority adverse effects to inform the client about.

2. A client with active tuberculosis asks why he must take four different medications. Which of the following responses should the nurse make?

• A. Four medications decrease the risk of a severe allergic reaction.
• B. Four medications reduce the chance that the bacteria will become resistant.
• C. Four medications reduce the risk of adverse reactions.
• D. Four medications decrease the chance of having a positive tuberculin skin test.

Correct answer: B

Rationale: The correct answer is B. When treating tuberculosis, using a combination of medications is crucial to reduce the risk of bacteria developing resistance to any single drug. This approach helps prevent treatment failure and ensures successful treatment outcomes. Choice A is incorrect because the primary purpose of using multiple medications is not related to allergic reactions. Choice C is incorrect as the risk reduction is mainly focused on bacterial resistance rather than adverse reactions. Choice D is not relevant as the purpose of taking multiple medications is not to affect the tuberculin skin test results.

3. A client has been prescribed Prednisone for an inflammatory condition and is receiving discharge teaching from a nurse. Which of the following instructions should the nurse include?

• A. Take this medication on an empty stomach.
• B. Avoid alcohol while taking this medication.
• C. Monitor your blood pressure regularly.
• D. Take this medication in the morning to prevent insomnia.

Correct answer: D

Rationale: The correct answer is to take Prednisone in the morning to prevent insomnia. Prednisone can cause insomnia as a side effect, so taking it in the morning can help minimize this issue. It is important to follow the healthcare provider's instructions regarding the timing of Prednisone administration to optimize its effectiveness and minimize adverse effects.

4. A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?

• A. Reduced cardiac function
• B. First-pass effect
• C. Reduced hepatic function
• D. Increased gastric motility

Correct answer: C

Rationale: In older adults, reduced hepatic function can lead to prolonged effects of medications metabolized by the liver. This situation can result in increased drug levels in the body, causing drowsiness and other side effects. Adjusting the dosage of the hypnotic medication may be necessary to prevent such adverse effects in older adult clients. Choice A, reduced cardiac function, is not directly related to the metabolism of the medication and is unlikely to cause drowsiness. Choice B, first-pass effect, refers to the initial metabolism of a drug in the liver before it enters circulation, but it is not the cause of drowsiness in this scenario. Choice D, increased gastric motility, does not play a significant role in the metabolism of the medication and is not a likely cause of the client's drowsiness.

5. A client is prescribed Amitriptyline for depression. What should the nurse include in the teaching? (Select all that apply.)

• A. Expect therapeutic effects in 1-3 weeks.
• B. Discontinue the medication gradually under healthcare provider supervision.
• C. Change positions slowly to minimize dizziness.
• D. Increase dietary fiber intake to prevent constipation.

Correct answer: C

Rationale: The correct answer is C. Changing positions slowly can help prevent orthostatic hypotension, a common adverse effect of tricyclic antidepressants like Amitriptyline. It is essential to educate the client to avoid sudden position changes to minimize the risk of dizziness and falls. Choices A, B, and D are incorrect. The therapeutic effects of Amitriptyline may not be noticeable for 1-3 weeks, so expecting them in 24 to 48 hours (choice A) is unrealistic. Discontinuing the medication abruptly can lead to withdrawal symptoms and should be done gradually under healthcare provider supervision, so choice B is incorrect. Amitriptyline can actually cause constipation, so increasing dietary fiber intake would be recommended to prevent constipation, making choice D incorrect.

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