Nursing Elites

1. Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:

• A. Increase DNA and RNA synthesis.
• B. Promote the biosynthesis of nucleic acids.
• C. Increase estrogen concentration and estrogen response.
• D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Correct answer: D

Rationale: The primary action of tamoxifen, an antineoplastic medication used in metastatic breast carcinoma, is to compete with estradiol for binding to estrogen receptors in tissues with high receptor concentrations. By doing so, tamoxifen reduces DNA synthesis and estrogen response, leading to its therapeutic effect in inhibiting the growth of estrogen-sensitive breast cancer cells.

2. A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?

• A. Monitor for renal failure.
• B. Monitor psychosocial status.
• C. Monitor for signs of bleeding.
• D. Have heparin sodium available.

Correct answer: C

Rationale: The priority nursing intervention for a client receiving tissue plasminogen activator (alteplase) for an acute myocardial infarction is to monitor for signs of bleeding. Alteplase is a thrombolytic medication that can lead to hemorrhage as a complication. Therefore, closely monitoring the client for any signs of bleeding is essential to promptly address and manage this potential adverse effect.

3. A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva). Which instruction should the nurse include in the teaching plan?

• A. Use the medication as a rescue inhaler.
• B. Rinse your mouth after using the inhaler.
• C. Take the medication on an empty stomach.
• D. Take the medication with a full glass of water.

Correct answer: B

Rationale: Tiotropium (Spiriva) is not a rescue inhaler but a maintenance medication for COPD. The correct instruction for the nurse to include in the teaching plan is to advise the client to rinse their mouth after using the inhaler. This practice helps prevent dry mouth and throat irritation, common side effects of tiotropium. There are no specific recommendations to take tiotropium on an empty stomach or with a full glass of water.

4. During an admission assessment, a client informs the nurse that they take propylthiouracil (PTU) daily. Based on this information, the nurse suspects that the client has a history of:

• A. Myxedema
• B. Graves' disease
• C. Addison's disease
• D. Cushing's syndrome

Correct answer: B

Rationale: Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, including Graves' disease, which is characterized by an overactive thyroid gland. The client mentioning the daily use of PTU indicates that they likely have a history of Graves' disease, as this medication helps manage the condition by reducing the production of thyroid hormones. Therefore, the correct answer is B: Graves' disease. Choice A, Myxedema, is incorrect as it refers to a condition of severe hypothyroidism, the opposite of hyperthyroidism. Choices C and D, Addison's disease and Cushing's syndrome, respectively, are unrelated to the use of PTU or hyperthyroidism, making them incorrect choices.

5. A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?

• A. Keep insulin vials refrigerated at all times.
• B. Rotate the insulin injection sites systematically.
• C. Increase the amount of insulin before unusual exercise.
• D. Monitor the urine acetone level to determine the insulin dosage.

Correct answer: B

Rationale: When a client is stabilized with daily insulin injections, it is crucial to rotate the injection sites systematically. This practice helps prevent the development of lipodystrophy, which can affect insulin absorption and lead to inconsistent glucose control. Additionally, rotating sites minimizes discomfort and tissue damage, ensuring optimal insulin delivery and effectiveness.

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