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An elderly client with heart failure arrives at the emergency room due to nausea, vomiting, and anorexia. Based on the client’s signs and symptoms, which piece of data from the medical history is most significant when planning this client’s care?
- A. The client underwent a coronary artery bypass procedure in 1995.
- B. The client had a colonoscopy performed for routine screening six months ago.
- C. The client suffered from depression following the death of their spouse in 1999.
- D. The client has been taking digoxin and furosemide daily since 1996.
Correct Answer: D
Rationale: Digoxin and furosemide (D) can cause nausea, vomiting, and anorexia due to toxicity (digoxin) or electrolyte imbalances (furosemide), critical for heart failure management. Past bypass (A), colonoscopy (B), and depression (C) are less relevant to current symptoms.
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A patient with nasal congestion has been prescribed phenylephrine 10 mg by mouth every 4 hours. What patient condition should the nurse report to the healthcare provider before administering the medication?
- A. Hypertension.
- B. Bronchitis.
- C. Diarrhea.
- D. Edema.
Correct Answer: A
Rationale: Phenylephrine, a decongestant, can raise blood pressure, making hypertension (A) a contraindication requiring provider consultation. Bronchitis (B), diarrhea (C), and edema (D) are not directly affected by phenylephrine.
When administering medications to a group of patients, which patient should the nurse closely monitor for the development of acute kidney injury (AKI)?
- A. Patient on Vancomycin.
- B. Patient on Sucralfate.
- C. Patient on Lorazepam.
- D. Patient on Digoxin.
Correct Answer: A
Rationale: Vancomycin (A) is nephrotoxic and requires monitoring for AKI, especially with high doses or prolonged use. Sucralfate (B) protects the stomach, not kidneys. Lorazepam (C) and digoxin (D) have minimal renal toxicity risks.
A patient with osteoporosis is administered risedronate at 0700 and requests a glass of milk to take with the medication. What should the nurse’s response be?
- A. Advise the patient to only consume water with the medication.
- B. Delay the medication until the patient’s breakfast tray arrives.
- C. Consult with a pharmacist about administering the dose one hour post-meal.
- D. Assign an unlicensed assistive personnel to bring the patient a glass of low-fat milk.
Correct Answer: A
Rationale: This question is identical to Question 1. Risedronate requires plain water on an empty stomach (A) to ensure absorption. Milk (D) reduces efficacy. Delaying for breakfast (B) or post-meal dosing (C) violates guidelines. Note: Duplicate question; consider removing.
A patient is currently on an oral contraceptive and has been prescribed erythromycin. What advice should the nurse provide to the patient?
- A. Utilize an additional form of contraception.
- B. Immediately discontinue the oral contraceptive.
- C. Ensure a 12-hour gap between taking the medications.
- D. Avoid prolonged exposure to direct sunlight.
Correct Answer: A
Rationale: Erythromycin may reduce oral contraceptive efficacy by inducing hepatic metabolism. Using an additional contraceptive method (A) prevents unintended pregnancy. Discontinuing the contraceptive (B) is unnecessary. Timing gaps (C) don’t mitigate the interaction. Sunlight avoidance (D) relates to other antibiotics like tetracycline.
A patient with peptic ulcer disease has been prescribed cimetidine. Which statement made by the patient indicates the need for further instruction by the nurse?
- A. Decrease cigarette use to a pack per day.
- B. Notify the healthcare provider of lethargy.
- C. Take the medication an hour after antacids.
- D. Monitor for any signs of sexual dysfunction.
Correct Answer: C
Rationale: Cimetidine should be taken with meals or immediately after, not 1 hour after antacids (C), which interferes with absorption. Reducing smoking (A) is insufficient; cessation is ideal. Lethargy (B) and sexual dysfunction (D) are valid monitoring points.