Nursing Elites

1. The nurse is caring for a client who has chronic angina. Treatment for the condition has been unsuccessful. Which medication does the nurse anticipate will be prescribed?

• A. Atenolol (Tenormin)
• B. Nitroglycerin (Nitrostat)
• C. Sildenafil (Viagra)
• D. Ranolazine (Ranexa)

Correct answer: D

Rationale: In cases of chronic angina where initial treatment has not been successful, Ranolazine (Ranexa) is often prescribed. This medication helps by reducing the frequency of angina episodes. Atenolol, Nitroglycerin, and Sildenafil are also used in angina management but Ranolazine is more specifically indicated in cases of refractory angina where other treatments have failed.

2. A client has a new prescription for Atenolol. Which of the following instructions should the nurse provide?

• A. Take this medication with grapefruit juice.
• B. Monitor your blood pressure and heart rate regularly.
• C. You may experience a rapid heart rate.
• D. Increase your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct answer is B: 'Monitor your blood pressure and heart rate regularly.' Atenolol is a beta-blocker used to treat hypertension and other cardiovascular conditions. Patients should monitor their blood pressure and heart rate regularly to assess the medication's effectiveness and check for adverse effects like bradycardia or hypotension. Choice A is incorrect because Atenolol should not be taken with grapefruit juice, which can interfere with its absorption. Choice C is incorrect because Atenolol typically causes a decrease in heart rate, not a rapid heart rate. Choice D is incorrect because there is no specific need to increase potassium-rich foods while taking Atenolol.

3. A client is receiving treatment with methotrexate. Which of the following supplements should the nurse instruct the client to take?

• A. Folic acid
• B. Vitamin D
• C. Calcium
• D. Iron

Correct answer: A

Rationale: The nurse should instruct the client to take folic acid when receiving treatment with methotrexate to reduce the risk of methotrexate toxicity. Methotrexate acts as a folic acid antagonist, leading to folic acid deficiency, which can be counteracted by supplementing with folic acid. Vitamin D, calcium, and iron are not specifically recommended to counteract methotrexate effects and do not play a significant role in mitigating methotrexate toxicity.

4. When teaching a client with cancer who has a prescription for methotrexate, which supplement should the nurse instruct the client to take?

• A. Folic acid
• B. Magnesium
• C. Vitamin D
• D. Iron

Correct answer: A

Rationale: The correct answer is folic acid. Methotrexate is a folic acid antagonist, so instructing the client to take folic acid helps reduce the risk of methotrexate toxicity by providing additional folic acid that the medication may deplete. Magnesium (choice B), Vitamin D (choice C), and Iron (choice D) are not the correct supplements to instruct the client to take with methotrexate.

5. A client who has been taking prednisone to treat asthma is advised to discontinue the medication. The client should be instructed to reduce the dose gradually to prevent which of the following adverse effects?

• A. Hyperglycemia
• B. Adrenocortical insufficiency
• C. Severe dehydration
• D. Rebound pulmonary congestion

Correct answer: B

Rationale: Abruptly stopping prednisone can result in adrenocortical insufficiency due to suppression of the adrenal glands. Gradually tapering the dose helps the body adjust and resume its natural cortisol production, preventing adrenal insufficiency. Choice A, hyperglycemia, is a possible adverse effect of prednisone, but it is not the primary reason for gradual tapering. Severe dehydration (Choice C) and rebound pulmonary congestion (Choice D) are not typically associated with discontinuing prednisone.

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