Nursing Elites

1. What is a severe adverse effect of warfarin?

• A. Bleeding
• B. Arrhythmias
• C. Blurred vision
• D. Bradycardia

Correct answer: A

Rationale: A severe adverse effect of warfarin is bleeding. Warfarin is an anticoagulant medication that works by inhibiting blood clotting factors, which can lead to an increased risk of bleeding. Excessive bleeding can occur internally or externally, and it is crucial for individuals taking warfarin to be aware of this potential complication and seek medical attention if they experience any signs of bleeding. Arrhythmias, blurred vision, and bradycardia are not typically associated with warfarin use, making them incorrect choices.

2. A client with Addison's disease is being admitted for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. What is the nurse's priority action?

• A. Administering a supplemental dose of hydrocortisone
• B. Instructing the client about coughing and deep breathing
• C. Collecting additional information from the client about his history of Addison's disease
• D. Inserting an indwelling urinary catheter

Correct answer: A

Rationale: The nurse's priority in this situation is to administer a supplemental dose of hydrocortisone. Clients with Addison's disease taking hydrocortisone are at risk of acute adrenal insufficiency during times of stress such as surgery. Administering supplemental doses of hydrocortisone helps prevent acute adrenal insufficiency (adrenal crisis) in these situations, making it the priority action to ensure the client's safety. Instructing the client about coughing and deep breathing is important postoperatively but not the priority at this time. Collecting additional information about the client's history of Addison's disease is important but not the priority action before surgery. Inserting an indwelling urinary catheter is not the priority in this situation.

3. 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.

4. While collecting data from a client taking Gemfibrozil, a nurse should identify which of the following assessment findings as an adverse reaction to the medication?

• A. Mental status changes
• B. Tremor
• C. Jaundice
• D. Pneumonia

Correct answer: C

Rationale: Jaundice is an adverse reaction that the nurse should identify when assessing a client taking Gemfibrozil. It is associated with liver impairment, which can be a side effect of this medication. Mental status changes and tremors are not typically associated with Gemfibrozil use. Pneumonia is not a common adverse reaction to this medication, and its occurrence is not directly linked to Gemfibrozil use.

5. When reviewing a client's health record, a nurse notes a new prescription for Lisinopril 10 mg PO once daily. The nurse should identify this as which type of prescription?

• A. Single
• B. Stat
• C. Routine
• D. Standing

Correct answer: C

Rationale: A routine prescription indicates medications to be administered on a regular schedule without a termination date or a specific number of doses. In this case, Lisinopril 10 mg PO once daily falls under a routine prescription, meaning the nurse will administer this medication daily until the provider discontinues it. Choices A, B, and D are incorrect: A 'single' prescription is for a one-time dose, 'stat' prescriptions are for immediate administration, and 'standing' prescriptions are pre-authorized for administration as needed within specified parameters.

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