Nursing Elites

1. 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. The estrogenic effects of tamoxifen can further increase the risk of thromboembolic events, making it unsafe for individuals with a history of deep-vein thrombosis. Choice B (migraine headaches), Choice C (hypertension), and Choice D (anemia) are not contraindications for tamoxifen therapy. Migraine headaches, hypertension, and anemia do not pose the same risk of adverse effects related to blood clot formation as deep-vein thrombosis does.

2. A healthcare provider is preparing to administer an Opioid agonist to a client who has acute pain. Which of the following complications should the healthcare provider monitor?

• A. Urinary retention
• B. Tachypnea
• C. Hypertension
• D. Irritating cough

Correct answer: A

Rationale: The correct answer is urinary retention. Opioid agonists like morphine can suppress the sensation of a full bladder, leading to urinary retention. Monitoring for this complication is crucial to prevent bladder distention and related issues. Choices B, C, and D are incorrect. Tachypnea (increased respiratory rate), hypertension (high blood pressure), and irritating cough are not typically associated with opioid agonist administration for pain management.

3. A client with osteoporosis has a new prescription for alendronate. Which of the following instructions should the nurse provide?

• A. Take the medication with a meal.
• B. Remain upright for at least 30 minutes after taking the medication.
• C. Take the medication with a glass of juice.
• D. Take the medication with milk or food.

Correct answer: B

Rationale: The correct instruction for a client taking alendronate is to remain upright for at least 30 minutes after administration. This is essential to prevent esophageal irritation and ensure the medication reaches the stomach properly. Remaining upright reduces the risk of side effects such as esophagitis. Choices A, C, and D are incorrect as alendronate should not be taken with a meal, juice, milk, or food to optimize its absorption and effectiveness.

4. A client has a prescription for gentamicin for the treatment of an infection. Which finding indicates a potential adverse reaction to the medication?

• A. Blood pressure 160/90 mm Hg
• B. Presence of red blood cells in the urine
• C. Urine output of 35 mL/hr
• D. Respiratory rate of 22/min

Correct answer: B

Rationale: The presence of red blood cells in the urine can indicate nephrotoxicity, which is a potential adverse effect of gentamicin. Gentamicin can cause damage to the kidneys, leading to the presence of red blood cells in the urine as a sign of renal impairment. Monitoring for this finding is crucial to detect and manage adverse reactions promptly. High blood pressure (Choice A) is not typically associated with gentamicin use. Low urine output (Choice C) is more suggestive of kidney injury rather than nephrotoxicity specifically related to gentamicin. Respiratory rate (Choice D) is not a common indicator of adverse reactions to gentamicin.

5. A client has a new prescription for colchicine to treat gout. Which of the following instructions should be included?

• A. Take this medication with food if nausea develops.
• B. Monitor for muscle pain.
• C. Expect to have increased bruising.
• D. Increase your intake of grapefruit juice.

Correct answer: B

Rationale: Monitoring for muscle pain is crucial when taking colchicine because it can lead to rhabdomyolysis, a serious condition characterized by muscle breakdown. This adverse effect needs prompt identification to prevent complications. Choices A, C, and D are incorrect because taking colchicine with food, experiencing increased bruising, or increasing grapefruit juice intake are not relevant instructions for a client prescribed colchicine for gout.

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