Nursing Elites

1. A client in the post-anesthesia recovery unit received a nondepolarizing neuromuscular blocking agent and is experiencing muscle weakness. The nurse should anticipate a prescription for which of the following medications?

• A. Neostigmine
• B. Naloxone
• C. Dantrolene
• D. Vecuronium

Correct answer: A

Rationale: Neostigmine is a cholinesterase inhibitor commonly used to reverse the effects of nondepolarizing neuromuscular blockers by increasing acetylcholine levels at the neuromuscular junction, thereby helping to restore muscle strength. Naloxone is an opioid antagonist used to reverse opioid effects, not neuromuscular blockade. Dantrolene is a skeletal muscle relaxant used to treat malignant hyperthermia or neuroleptic malignant syndrome, not to reverse neuromuscular blockade. Vecuronium is a nondepolarizing neuromuscular blocking agent, like the one the client received, and is not used to reverse its effects.

2. A healthcare professional is planning to administer Morphine IV to a postoperative client. Which of the following actions should the healthcare professional take?

• A. Monitor for seizures and confusion with repeated doses.
• B. Protect the client's skin from severe diarrhea that occurs with morphine.
• C. Withhold this medication if the respiratory rate is less than 12/min.
• D. Administer Morphine intermittently via IV bolus over 30 seconds or less.

Correct answer: C

Rationale: The correct action the healthcare professional should take when administering Morphine IV to a postoperative client is to withhold the medication if the respiratory rate is less than 12/min. Respiratory depression is a common adverse effect of opioids like Morphine. Administering opioids when the respiratory rate is already compromised can further depress breathing, leading to life-threatening complications. Monitoring for seizures and confusion (Choice A) is not directly related to Morphine administration. Protecting the client's skin from severe diarrhea (Choice B) is not a common side effect of morphine. Administering Morphine via IV bolus (Choice D) should be done carefully but is not the most critical action in this scenario.

3. A healthcare provider is reviewing the health history of a client who is starting therapy with tamoxifen. The healthcare provider should recognize that tamoxifen is contraindicated in which of the following clients?

• A. A client with a history of deep-vein thrombosis
• B. A client with a history of migraine headaches
• C. A client with a history of hypertension
• D. A client with a history of anemia

Correct answer: A

Rationale: Tamoxifen is contraindicated in clients with a history of thromboembolic events, such as deep-vein thrombosis, due to the increased risk of blood clots forming and leading to serious complications like pulmonary embolism. Clients with a history of deep-vein thrombosis are at a higher risk of recurrent thromboembolic events when taking tamoxifen, making it unsafe for such individuals. Choices B, C, and D are not contraindications for tamoxifen therapy, as migraine headaches, hypertension, and anemia do not directly interact with tamoxifen's mechanism of action or pose significant risks when used together.

4. A client has a new prescription for Enoxaparin. Which of the following instructions should the nurse include?

• A. Massage the injection site after administration.
• B. Aspirate before injecting the medication.
• C. Administer the medication into the abdomen.
• D. Administer the medication via intramuscular injection.

Correct answer: C

Rationale: The correct answer is to administer the medication into the abdomen. Enoxaparin is a medication that is administered subcutaneously, typically in the abdomen to ensure proper absorption. Massaging the injection site should be avoided as it can lead to bruising or bleeding under the skin. Aspirating before injecting the medication is not necessary for subcutaneous injections like Enoxaparin. Administering the medication via intramuscular injection is incorrect as Enoxaparin should be given subcutaneously.

5. Which of the following conditions is not typically treated with Hydrochlorothiazide?

• A. CHF
• B. HTN
• C. Nephritis
• D. Hypercalciuria

Correct answer: C

Rationale: Nephritis is not commonly treated with Hydrochlorothiazide. Hydrochlorothiazide is primarily used for managing hypertension (HTN) and congestive heart failure (CHF) by reducing blood pressure and fluid retention. It is not a standard treatment for nephritis, which involves inflammation of the kidneys. Hypercalciuria, characterized by excessive calcium excretion in the urine, is not typically treated with Hydrochlorothiazide either.

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