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A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a potential contraindication to a medication for which of the following clients? (Select all that apply.)
- A. A client at 8 weeks of gestation who asks for an Influenza immunization
- B. A client who takes Prednisone and has a possible Fungal infection
- C. A client who has chronic liver disease and is taking Hydrocodone
- D. A client who has Peptic Ulcer Disease, takes Sucralfate, and tells the nurse she has started taking OTC Aluminum Hydroxide
Correct Answer: B
Rationale: Prednisone, a glucocorticoid, should not be taken by a client who has a possible systemic fungal infection as it can worsen the infection. This combination can suppress the immune response, allowing the fungal infection to proliferate. Therefore, the nurse should contact the provider regarding this potential contraindication to medication. The other options do not present a contraindication related to the medication interactions described in the question.
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A client has a new prescription for Beclomethasone. Which of the following instructions should the nurse include in the teaching?
- A. Take the medication with meals.
- B. Increase your intake of calcium-rich foods.
- C. Rinse your mouth after each use.
- D. Limit fluid intake while taking this medication.
Correct Answer: C
Rationale: The correct answer is C: 'Rinse your mouth after each use.' Beclomethasone can cause oral candidiasis (thrush) as an adverse effect. Rinsing the mouth after each use helps reduce the risk of developing thrush by removing any residue of the medication from the mouth, which can promote fungal growth. Choices A, B, and D are incorrect. Taking the medication with meals, increasing calcium-rich foods intake, or limiting fluid intake are not specific instructions related to minimizing the side effect of oral candidiasis associated with Beclomethasone.
A client is starting a new prescription for levothyroxine. Which of the following instructions should the nurse include?
- A. Take the medication at bedtime.
- B. Take the medication with food.
- C. Take the medication first thing in the morning on an empty stomach.
- D. Take the medication with a full glass of milk.
Correct Answer: C
Rationale: The correct instruction for taking levothyroxine is to take the medication first thing in the morning on an empty stomach. This timing is important for optimal absorption of the medication. Taking levothyroxine with food or at bedtime can interfere with its absorption. Milk and other foods, as well as certain medications, can reduce the effectiveness of levothyroxine by interfering with its absorption, so it should be taken separately from these items. Therefore, the correct choice is to take the medication first thing in the morning on an empty stomach.
A client has a new prescription for Metformin to treat type 2 diabetes. Which of the following laboratory results should be monitored?
- A. Hemoglobin A1C
- B. Liver function tests
- C. Electrolyte levels
- D. Kidney function
Correct Answer: D
Rationale: Metformin is excreted by the kidneys, and impaired kidney function can lead to an increased risk of lactic acidosis, a serious side effect. Therefore, it is important to monitor kidney function regularly while a client is on Metformin. Hemoglobin A1C is used to monitor long-term glucose control, but kidney function is the priority for monitoring Metformin therapy.
A client has a new prescription for nitroglycerin. Which of the following adverse effects should the nurse instruct the client to report that can indicate the medication is effective?
- A. Headache
- B. Nausea
- C. Dizziness
- D. Dry mouth
Correct Answer: A
Rationale: Headache is a common side effect of nitroglycerin due to its vasodilatory effects. It can indicate that the medication is working effectively by dilating blood vessels, improving blood flow, and reducing cardiac workload. Therefore, the client should report experiencing headaches as it may suggest the therapeutic action of nitroglycerin. Nausea, dizziness, and dry mouth are not typically associated with the therapeutic effects of nitroglycerin and should be reported as adverse effects that may necessitate medical attention.
Which of the following drugs has a therapeutic effect that increases cardiac output and slows heart rate?
- A. Heparin
- B. Alprazolam
- C. Digoxin
- D. Levothyroxine
Correct Answer: C
Rationale: Digoxin is the correct answer. It is a medication known for its positive inotropic effects, which increase cardiac output, and negative chronotropic effects, which slow the heart rate. These effects are achieved by inhibiting the sodium-potassium ATPase pump in myocardial cells. Therefore, Digoxin is commonly prescribed to manage conditions like heart failure and atrial fibrillation, where enhancing cardiac output and reducing heart rate are beneficial. Choices A, B, and D are incorrect because Heparin is an anticoagulant, Alprazolam is a benzodiazepine used for anxiety disorders, and Levothyroxine is a thyroid hormone replacement drug, none of which have the specified therapeutic effects on cardiac function.