Nursing Elites

1. A client has a new prescription for Digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching?

• A. Contact provider if heart rate is less than 60/min.
• B. Check pulse rate for 30 seconds and multiply the result by 2.
• C. Increase intake of sodium.
• D. Take with food if nausea occurs.

Correct answer: A

Rationale: The correct instruction for a client prescribed Digoxin for heart failure is to contact the provider if the heart rate is less than 60/min. Digoxin can affect heart rate, and a heart rate below 60/min may indicate toxicity, requiring prompt medical attention. Checking the pulse rate accurately and seeking medical advice are essential components of safe medication management. Choices B, C, and D are incorrect. Choice B is related to checking the pulse rate but does not address the critical action of contacting the provider if it is below 60/min. Increasing intake of sodium (Choice C) is inappropriate as high sodium levels can worsen heart failure. Taking Digoxin with food if nausea occurs (Choice D) does not address a critical aspect of Digoxin administration related to heart rate monitoring.

2. A client with cirrhosis is about to receive a dose of lactulose. The client questions the need for the medication, stating they are not constipated. The nurse should explain that lactulose is used in cirrhosis to reduce levels of which component in the bloodstream?

• A. Glucose
• B. Ammonia
• C. Potassium
• D. Bicarbonate

Correct answer: B

Rationale: Lactulose is administered to clients with cirrhosis to lower blood ammonia levels, thus aiding in the prevention of hepatic encephalopathy. Elevated ammonia levels in cirrhosis can lead to cognitive impairment and hepatic encephalopathy. Therefore, the correct answer is B (Ammonia). Glucose (Choice A) is not the component targeted by lactulose in cirrhosis. Potassium (Choice C) and Bicarbonate (Choice D) are not directly affected by lactulose administration in cirrhosis.

3. A client has a new prescription for Spironolactone. Which of the following findings should the nurse monitor as an adverse effect?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

Correct answer: A

Rationale: Corrected Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as an adverse effect. Hyperkalemia can result in muscle weakness and cardiac dysrhythmias, making it essential for the nurse to monitor potassium levels closely when a client is on Spironolactone. Choice B, Hypoglycemia, is incorrect because Spironolactone is not known to cause low blood sugar levels. Choice C, Hypocalcemia, and Choice D, Hyponatremia, are also incorrect as Spironolactone is not associated with decreased levels of calcium or sodium.

4. A client is receiving imatinib. Which of the following adverse effects should the nurse monitor?

• A. Edema
• B. Constipation
• C. Dry mouth
• D. Urinary retention

Correct answer: A

Rationale: The correct answer is A: Edema. The nurse should monitor the client for edema when receiving imatinib. Imatinib, a tyrosine kinase inhibitor, can lead to fluid retention and edema as a common adverse effect. This can manifest as swelling in various parts of the body, indicating the need for close monitoring by the nurse to prevent complications related to fluid overload. Choices B, C, and D are incorrect because constipation, dry mouth, and urinary retention are not typically associated with imatinib use. Therefore, they are not the priority adverse effects to monitor in a client receiving this medication.

5. A staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply.)

• A. Increased renal secretion
• B. Increased medication-metabolizing enzymes
• C. Liver failure
• D. Peripheral vascular disease

Correct answer: C

Rationale: Liver failure impairs metabolism, leading to increased medication concentrations. When liver function is compromised, lower dosages are necessary to prevent adverse effects. Increased renal secretion is not a reason for lower medication dosages, as it primarily affects excretion rather than metabolism. Increased medication-metabolizing enzymes would usually require higher dosages to achieve the desired effect. Peripheral vascular disease does not directly impact medication metabolism or dosage requirements.

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