Nursing Elites

1. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?

• A. Tremors
• B. Dizziness
• C. Confusion
• D. Hallucinations

Correct answer: C

Rationale: Older clients are particularly vulnerable to central nervous system side effects of cimetidine. The most frequent side effect is confusion. It is crucial for nurses to be vigilant in monitoring for confusion as it can impact the client's safety and well-being. While tremors, dizziness, and hallucinations are possible side effects, confusion is the most common in older clients taking cimetidine.

2. Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to:

• A. Take the medication at bedtime.
• B. Take the medication in the morning with breakfast.
• C. Lie down for 30 minutes after taking the medication.
• D. Take the medication with a full glass of water after rising in the morning.

Correct answer: D

Rationale: Alendronate (Fosamax) should be taken with a full glass of water after rising in the morning to prevent gastrointestinal side effects and increase absorption. Taking the medication with a full glass of water and in an upright position after waking up helps decrease the risk of esophageal irritation and enhances the drug's effectiveness by ensuring proper absorption in the gastrointestinal tract.

3. A client is being monitored while receiving bethanechol chloride (Urecholine) for urinary retention. Which of the following indicates a therapeutic effect of this medication?

• A. Increased heart rate
• B. Increased peristalsis
• C. Passage of flatus
• D. Urinary output of 50 mL per hour

Correct answer: D

Rationale: Bethanechol chloride (Urecholine) is administered to stimulate the bladder and treat urinary retention. The therapeutic effect is indicated by an increased urinary output, as it demonstrates the medication's ability to prompt the bladder to empty. Increased heart rate and passage of flatus are unrelated to the therapeutic effects of bethanechol. Although bethanechol can increase peristalsis, the primary therapeutic goal is to address urinary retention.

4. The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?

• A. Alopecia
• B. Chest pain
• C. Pulmonary fibrosis
• D. Orthostatic hypotension

Correct answer: D

Rationale: The correct answer is 'D: Orthostatic hypotension.' Etoposide is associated with orthostatic hypotension, a sudden drop in blood pressure that can occur when transitioning from lying down to standing up. It is important for the nurse to monitor the client's blood pressure during the infusion to detect and manage this potential side effect.

5. Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?

• A. Neuralgia
• B. Insomnia
• C. Use of nitroglycerin
• D. Use of multivitamins

Correct answer: C

Rationale: The correct answer is C. Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide and is contraindicated with the concurrent use of organic nitrates and nitroglycerin. Using nitroglycerin together with Viagra can lead to severe hypotension and cardiovascular collapse, making it unsafe to combine both medications.

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