Nursing Elites

1. Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:

• A. Increase DNA and RNA synthesis.
• B. Promote the biosynthesis of nucleic acids.
• C. Increase estrogen concentration and estrogen response.
• D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Correct answer: D

Rationale: The primary action of tamoxifen, an antineoplastic medication used in metastatic breast carcinoma, is to compete with estradiol for binding to estrogen receptors in tissues with high receptor concentrations. By doing so, tamoxifen reduces DNA synthesis and estrogen response, leading to its therapeutic effect in inhibiting the growth of estrogen-sensitive breast cancer cells.

2. A client with hyperlipidemia is prescribed atorvastatin (Lipitor). Which instruction should the nurse include in the teaching plan?

• A. Take the medication in the morning.
• B. Avoid consuming grapefruit juice.
• C. Increase your intake of dairy products.
• D. Take the medication with food.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the teaching plan is to advise the client to avoid consuming grapefruit juice. Grapefruit juice can increase the risk of atorvastatin (Lipitor) toxicity by inhibiting its metabolism. Atorvastatin is typically taken in the evening as cholesterol synthesis occurs at night. Increasing dairy intake is not specifically recommended for atorvastatin therapy, and the medication can be taken with or without food.

3. A healthcare professional is monitoring a client who is receiving intravenous amphotericin B. Which of the following should prompt the healthcare professional to notify the healthcare provider immediately?

• A. Fever
• B. Headache
• C. Nausea
• D. Oliguria

Correct answer: D

Rationale: Amphotericin B is known to cause nephrotoxicity, which can lead to kidney damage. Oliguria, which is decreased urine output, is a concerning sign of kidney dysfunction and should be reported promptly to the healthcare provider to prevent further complications. Fever, headache, and nausea are common side effects of amphotericin B but are not as critical as oliguria in indicating potential kidney damage.

4. A client is receiving instructions from a healthcare provider about intranasal desmopressin acetate (DDAVP). The healthcare provider explains that which of the following is a side effect of the medication?

• A. Headache
• B. Vulval pain
• C. Runny nose
• D. Flushed skin

Correct answer: C

Rationale: Intranasal desmopressin can cause a runny or stuffy nose as a side effect due to its mode of administration through the nasal passages.

5. A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva). Which instruction should the nurse include in the teaching plan?

• A. Use the medication as a rescue inhaler.
• B. Rinse your mouth after using the inhaler.
• C. Take the medication on an empty stomach.
• D. Take the medication with a full glass of water.

Correct answer: B

Rationale: Tiotropium (Spiriva) is not a rescue inhaler but a maintenance medication for COPD. The correct instruction for the nurse to include in the teaching plan is to advise the client to rinse their mouth after using the inhaler. This practice helps prevent dry mouth and throat irritation, common side effects of tiotropium. There are no specific recommendations to take tiotropium on an empty stomach or with a full glass of water.

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