Nursing Elites

1. A healthcare provider is reviewing the health care record of a client who is asking about conjugated equine estrogens. The provider should inform the client this medication is contraindicated in which of the following conditions?

• A. Atrophic vaginitis
• B. Dysfunctional uterine bleeding
• C. Osteoporosis
• D. Thrombophlebitis

Correct answer: D

Rationale: Conjugated equine estrogens are contraindicated in clients with a history of thrombophlebitis due to the increased risk of thrombotic events associated with estrogen use. Thrombophlebitis is characterized by inflammation of a vein with the formation of a clot, and estrogen can further exacerbate this condition, leading to serious complications. Choices A, B, and C are not contraindications for conjugated equine estrogens. Atrophic vaginitis and osteoporosis are conditions where estrogen therapy may actually be indicated. Dysfunctional uterine bleeding is another condition where estrogen therapy can be used to help regulate menstrual bleeding.

2. A client received IV Verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min, and blood pressure is 74/44 mm Hg. The nurse should anticipate a prescription for which of the following IV medications?

• A. Calcium gluconate
• B. Sodium bicarbonate
• C. Potassium chloride
• D. Magnesium sulfate

Correct answer: A

Rationale: In this situation, where the client's blood pressure is significantly lowered due to Verapamil administration, the nurse should anticipate a prescription for Calcium gluconate. Calcium gluconate is used to reverse severe hypotension caused by Verapamil. It should be given slowly intravenously as it counteracts the vasodilation caused by Verapamil, helping to normalize blood pressure levels. Sodium bicarbonate is not indicated for low blood pressure. Potassium chloride and magnesium sulfate are not the appropriate choices to address hypotension caused by Verapamil.

3. A client with Angina Pectoris asks the nurse about the next step if they take one tablet, wait 5 minutes, but still have Anginal pain. Which response should the nurse provide?

• A. Take two more sublingual tablets at the same time.
• B. Call emergency services.
• C. Take a sustained-release nitroglycerin capsule.
• D. Wait another 5 minutes then take a second sublingual tablet.

Correct answer: B

Rationale: If anginal pain persists after taking the first tablet and waiting 5 minutes, the priority step is to call emergency services (911) and then take a second sublingual tablet. Persistent pain could indicate a myocardial infarction, and immediate medical attention is crucial. Taking two more tablets at the same time (Choice A) can lead to excessive vasodilation and hypotension. Taking a sustained-release nitroglycerin capsule (Choice C) is not appropriate for immediate relief during an acute episode. Waiting another 5 minutes and then taking a second tablet (Choice D) is not advisable in this emergency situation where prompt action is necessary.

4. When teaching a client who has a prescription for Lisinopril, which of the following instructions should the nurse include?

• A. Take the medication at bedtime.
• B. Monitor for a persistent cough.
• C. Expect to have increased appetite.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: The correct answer is B: 'Monitor for a persistent cough.' Lisinopril, an ACE inhibitor, can cause a persistent dry cough as a side effect. It is essential for the client to report this symptom to their healthcare provider for further evaluation and management. Choice A is incorrect because Lisinopril is typically taken in the morning. Choice C is incorrect as Lisinopril is not known to cause increased appetite. Choice D is also incorrect as Lisinopril can lead to increased potassium levels in the blood, so avoiding foods high in potassium is not necessary.

5. When educating a client with early Parkinson's disease about pramipexole, what adverse effect should the nurse advise the client to monitor for?

• A. Hallucinations
• B. Increased salivation
• C. Diarrhea
• D. Discoloration of urine

Correct answer: A

Rationale: The correct answer is A: Hallucinations. Pramipexole can lead to hallucinations, especially within 9 months of starting the medication, and may necessitate discontinuation. Hallucinations are a serious adverse effect that the client should be aware of and report promptly to their healthcare provider for evaluation and management. Increased salivation (choice B), diarrhea (choice C), and discoloration of urine (choice D) are not common adverse effects associated with pramipexole and are not typically emphasized in client education for this medication.

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