Nursing Elites

1. A client receiving enalapril reports a persistent dry cough. The nurse should explain that this side effect is related to which medication action?

• A. It reduces the production of angiotensin II.
• B. It increases the production of angiotensin II.
• C. It causes increased production of bradykinin.
• D. It increases the production of aldosterone.

Correct answer: C

Rationale: The correct answer is C. Enalapril, an ACE inhibitor, inhibits the conversion of angiotensin I to angiotensin II, leading to increased levels of bradykinin. The accumulation of bradykinin is responsible for the persistent dry cough associated with ACE inhibitors like enalapril. Choices A, B, and D are incorrect because enalapril does not directly affect the production of angiotensin II or aldosterone. Instead, it primarily impacts the renin-angiotensin-aldosterone system by inhibiting the conversion of angiotensin I to angiotensin II, leading to bradykinin accumulation.

2. A client diagnosed with a sinus infection is prescribed ampicillin sodium. The practical nurse (PN) should instruct the client to notify the healthcare provider immediately if which symptom occurs?

• A. Rash
• B. Nausea
• C. Headache
• D. Dizziness

Correct answer: A

Rationale: The correct answer is A - Rash. Rash is the most common adverse side effect of all generations of penicillin, indicating an allergy to the medication. An allergic reaction could lead to anaphylactic shock, a severe and potentially life-threatening emergency. It is crucial for the client to inform the healthcare provider promptly if a rash develops after taking ampicillin sodium.

3. A client with bipolar disorder is taking lithium. Which client assessment data would indicate a potential adverse effect of lithium therapy?

• A. Increased appetite
• B. Dry mouth and increased thirst
• C. Tremors and polyuria
• D. Constipation

Correct answer: B

Rationale: When assessing a client taking lithium, dry mouth and increased thirst are indicators of potential adverse effects. Lithium can lead to nephrogenic diabetes insipidus, causing polyuria and subsequent increased thirst due to impaired water reabsorption in the kidneys. Tremors can also be a sign of lithium toxicity. Monitoring and recognizing these symptoms are crucial in managing lithium therapy and preventing further complications.

4. A client with gastroesophageal reflux disease (GERD) is prescribed omeprazole. The nurse should reinforce which instruction?

• A. Take this medication in the morning before breakfast.
• B. Take this medication with meals.
• C. Avoid taking this medication with antacids.
• D. Take this medication at bedtime.

Correct answer: A

Rationale: The correct instruction for a client with GERD prescribed omeprazole is to take the medication in the morning before breakfast. Omeprazole works best when taken on an empty stomach, approximately 30 minutes before the first meal of the day. This timing maximizes its effectiveness in reducing stomach acid production and helps manage symptoms of GERD more efficiently. Choice B is incorrect because taking omeprazole with meals may reduce its efficacy as it needs an empty stomach for optimal absorption. Choice C is incorrect because omeprazole can be taken with or without food, but it should not be taken with antacids as they can affect its absorption. Choice D is incorrect because taking omeprazole at bedtime is less effective compared to taking it before breakfast due to the circadian rhythm of gastric acid secretion.

5. A client with osteoporosis is prescribed alendronate. The practical nurse (PN) should reinforce which instruction regarding the administration of this medication?

• A. Take the medication with a full glass of water before breakfast.
• B. Take the medication immediately after a meal.
• C. Lie down for 30 minutes after taking the medication.
• D. Crush the medication and mix it with food.

Correct answer: A

Rationale: The correct instruction for administering alendronate is to take the medication with a full glass of water before breakfast. This timing is crucial to ensure proper absorption in the body and reduce the risk of esophageal irritation. Taking it immediately after a meal or lying down for 30 minutes after may affect absorption and increase the risk of adverse effects. It should not be crushed or mixed with food to maintain its effectiveness.

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