Nursing Elites

1. A client has a prescription for Trimethoprim-Sulfamethoxazole. Which of the following instructions should the nurse include?

• A. Take the medication with food.
• B. Increase fluid intake.
• C. Expect reddish-orange urine.
• D. Avoid high-protein foods.

Correct answer: B

Rationale: The correct instruction for a client prescribed Trimethoprim-Sulfamethoxazole is to increase fluid intake. This helps prevent crystalluria and kidney stones, which are potential adverse effects of this medication. Adequate hydration is essential to reduce the risk of these complications.

2. A toddler is being admitted to the hospital after an Acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this patient?

• A. Acetylcysteine
• B. Pegfilgrastim
• C. Misoprostol
• D. Naltrexone

Correct answer: A

Rationale: In cases of Acetaminophen overdose, acetylcysteine is the antidote of choice. Acetylcysteine helps prevent liver damage by replenishing depleted glutathione levels, which is essential for detoxifying acetaminophen metabolites. Pegfilgrastim is a medication used to stimulate white blood cell production, Misoprostol is a medication for preventing stomach ulcers, and Naltrexone is used for treating opioid addiction and alcoholism, but none of these are indicated for Acetaminophen overdose.

3. A client with end-stage cancer receiving Morphine is prescribed Methylnaltrexone. The client's daughter asks why the provider prescribed Methylnaltrexone. Which of the following responses should the nurse make?

• A. The medication will increase your mother's respirations.
• B. The medication will prevent dependence on the Morphine.
• C. The medication will relieve your mother's constipation.
• D. The medication works with the Morphine to increase pain relief.

Correct answer: C

Rationale: The correct response is C: 'The medication will relieve your mother's constipation.' Methylnaltrexone is an opioid antagonist used to treat severe constipation unrelieved by laxatives in opioid-dependent clients. It works by blocking the mu opioid receptors in the GI tract, which helps alleviate constipation without affecting pain relief or causing withdrawal symptoms. Choices A, B, and D are incorrect. Methylnaltrexone's primary action is related to managing constipation rather than increasing respirations, preventing dependence on Morphine, or enhancing pain relief when used alongside Morphine.

4. A client with breast cancer is being taught about Tamoxifen. Which of the following adverse effects of tamoxifen should the client be informed about?

• A. Irregular heart rhythm
• B. Abnormal uterine bleeding
• C. Yellowing of the sclera or dark-colored urine
• D. Difficulty swallowing

Correct answer: B

Rationale: Abnormal uterine bleeding is a known adverse effect of tamoxifen. It is important to educate the client about this side effect as those taking tamoxifen are at an increased risk for endometrial cancer. Any abnormal uterine bleeding should be promptly reported and evaluated by healthcare providers to ensure timely management and monitoring. The other options, such as irregular heart rhythm, yellowing of the sclera or dark-colored urine, and difficulty swallowing, are not typically associated with tamoxifen use and are not commonly reported adverse effects. Therefore, they are not the priority adverse effects to inform the client about.

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

• A. Notify the provider if you plan to become pregnant.
• B. Take the medication 1 hour before planning to go to sleep.
• C. Allow at least 6 hours for sleep when taking zolpidem.
• D. Do not take zolpidem with a bedtime snack.

Correct answer: A

Rationale: Zolpidem is classified as Pregnancy Risk Category C. It is important for the client to inform the provider if they plan to become pregnant because the medication may need to be adjusted or changed to ensure the safety of the fetus. This communication allows for appropriate monitoring and adjustments to be made to the treatment plan. Choice B is incorrect because zolpidem should be taken just before going to bed, not specifically 1 hour before. Choice C is incorrect as zolpidem is a short-acting medication, and it does not require a full 6 hours for sleep. Choice D is incorrect because zolpidem can be taken with or without food, so taking it with a bedtime snack is not contraindicated.

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