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 has a new prescription for hydrochlorothiazide. The client should monitor for which of the following adverse effects?

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

Correct answer: A

Rationale: Hyponatremia is a potential adverse effect of hydrochlorothiazide due to its diuretic action. Hydrochlorothiazide is a thiazide diuretic that can cause sodium and water loss, potentially leading to hyponatremia. Monitoring for symptoms such as weakness, confusion, and muscle cramps can help detect hyponatremia early. Ototoxicity (choice B) is not a common adverse effect of hydrochlorothiazide. Hypoglycemia (choice C) is not typically associated with hydrochlorothiazide use. Hyperkalemia (choice D) is more commonly associated with potassium-sparing diuretics rather than thiazide diuretics like hydrochlorothiazide.

3. A client is starting to take amitriptyline. The healthcare provider should instruct the client to monitor for which of the following adverse effects?

• A. Diarrhea
• B. Urinary retention
• C. Bradycardia
• D. Dry cough

Correct answer: B

Rationale: The correct answer is B: Urinary retention. Amitriptyline, a tricyclic antidepressant, can cause relaxation of the bladder sphincter muscles, leading to urinary retention. Monitoring for urinary retention is crucial as it is a common anticholinergic effect associated with this medication. Diarrhea (choice A) is not a common adverse effect of amitriptyline. Bradycardia (choice C) is more commonly associated with beta-blockers rather than tricyclic antidepressants like amitriptyline. Dry cough (choice D) is not a typical adverse effect of amitriptyline.

4. A client with Bipolar disorder has a new prescription for Carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

• A. This medication can safely be taken during pregnancy.
• B. Eliminate grapefruit juice from your diet.
• C. You will need to have a complete blood count and carbamazepine levels drawn periodically.
• D. Notify your provider if you develop a rash.

Correct answer: B

Rationale: The correct answer is B: "Eliminate grapefruit juice from your diet." Grapefruit juice affects carbamazepine metabolism and should be avoided. It can lead to increased levels of the medication, potentially causing toxicity. Monitoring carbamazepine blood levels and the complete blood count (CBC) is essential to ensure the medication's efficacy and safety. Although choice A is incorrect (This medication can safely be taken during pregnancy), carbamazepine is classified as a Pregnancy Category D drug, which means there is positive evidence of human fetal risk. Choice D (Notify your provider if you develop a rash) is also important because carbamazepine can cause serious adverse effects like Stevens-Johnson syndrome, which can be life-threatening. Regular monitoring and prompt reporting of any rash are crucial. Therefore, choices C and D are also relevant instructions for the client.

5. A client with Preeclampsia is receiving Magnesium Sulfate IV continuous infusion. Which of the following findings should the nurse report to the provider?

• A. 2+ deep tendon reflexes
• B. 2+ pedal edema
• C. 24 mL/hr urinary output
• D. Respirations 12/min

Correct answer: C

Rationale: In a client receiving Magnesium Sulfate IV for Preeclampsia, a urinary output less than 25 to 30 mL/hr indicates magnesium sulfate toxicity and should be reported to the provider for further evaluation and management. Choice A, 2+ deep tendon reflexes, is a normal finding with magnesium sulfate therapy. Choice B, 2+ pedal edema, is expected in clients with preeclampsia but does not indicate magnesium sulfate toxicity. Choice D, respirations 12/min, is within the normal range and not a concerning finding related to magnesium sulfate administration.

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