Nursing Elites

1. When teaching a client with a new prescription for Warfarin, which herbal supplement should the nurse instruct the client to avoid?

• A. St. John's wort
• B. Echinacea
• C. Garlic
• D. Ginseng

Correct answer: A

Rationale: The correct answer is St. John's wort. St. John's wort can reduce the effectiveness of Warfarin by interacting with its metabolism, potentially leading to decreased anticoagulant effects. Therefore, the nurse should instruct the client to avoid using St. John's wort while taking Warfarin to prevent adverse drug interactions. Echinacea, garlic, and ginseng are not the correct answers in this case. While these herbal supplements may also interact with Warfarin and affect its efficacy, St. John's wort has a well-known interaction with Warfarin that can significantly impact its anticoagulant effects. Educating the client about the specific interaction between St. John's wort and Warfarin is crucial to ensure patient safety and the medication's therapeutic benefit.

2. Which medication is a beta blocker?

• A. Atenolol (Tenormin)
• B. Verapamil (Calan)
• C. Captopril (Capoten)
• D. Clopidogrel (Plavix)

Correct answer: A

Rationale: Atenolol (Tenormin) is a beta blocker commonly used to treat conditions like hypertension and angina by blocking the action of adrenaline on the heart. Verapamil is a calcium channel blocker, Captopril is an ACE inhibitor, and Clopidogrel is an antiplatelet medication. Therefore, the correct answer is Atenolol (Tenormin) as it belongs to the beta blocker class of medications.

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

• A. Brush and floss your teeth regularly.
• B. Avoid drinking grapefruit juice.
• C. Take this medication with food.
• D. Increase your intake of calcium-rich foods.

Correct answer: A

Rationale: The correct answer is to instruct the client to brush and floss their teeth regularly. Phenytoin can lead to gingival hyperplasia, making oral hygiene crucial to prevent complications. Encouraging good oral care practices helps reduce the risk of adverse effects on the gums and teeth. Avoiding grapefruit juice is not specifically related to Phenytoin. While some medications require intake with food, Phenytoin is usually taken on an empty stomach for better absorption. Increasing calcium-rich foods is not directly associated with Phenytoin therapy.

4. A client with a history of migraine headaches is starting prophylaxis therapy with Propranolol. Which of the following findings in the client history should be reported to the provider by the nurse?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with a first-degree heart block due to its negative chronotropic properties that can further slow the heart rate. This can worsen conduction through the atrioventricular node, potentially leading to heart block progression. Therefore, the nurse should report the finding of a first-degree heart block to the provider before initiating Propranolol therapy. Choices A, B, and C are not contraindications for Propranolol therapy. A prior myocardial infarction, taking warfarin for atrial fibrillation, or using an SSRI for depression do not directly impact the initiation of Propranolol therapy in a client with a history of migraine headaches.

5. The client makes which statement about lifestyle changes to reduce the development and progression of coronary artery disease that indicates the need for further teaching?

• A. “I will check my weight regularly for any gain or loss.”
• B. “I’ll make sure to take my high blood pressure medications.”
• C. “I am attending a smoking cessation class.”
• D. “As long as I exercise, stress at my job will not bother me.”

Correct answer: D

Rationale: The client stating, 'As long as I exercise, stress at my job will not bother me,' indicates a misunderstanding of the relationship between exercise and stress management. It is important to clarify that while exercise can help reduce stress, it may not eliminate all stressors, especially those related to work. Further teaching is needed to ensure the client understands the multifactorial approach required to address stress and its impact on coronary artery disease.

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