Nursing Elites

1. A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention for signs of digoxin toxicity?

• A. Apical heart rate of 60 beats/min
• B. Sweating across the forehead
• C. Poor sucking effort
• D. Respiratory rate of 30 breaths/min

Correct answer: A

Rationale: A heart rate of 60 beats/min for a 6-month-old infant warrants immediate intervention as it falls below the normal range. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered within normal limits. Bradycardia (heart rate <60 beats/min) in infants can be a sign of digoxin toxicity, necessitating prompt evaluation and intervention to prevent adverse effects. Sweating across the forehead (Choice B) is a non-specific symptom and may not directly indicate digoxin toxicity. Poor sucking effort (Choice C) and a respiratory rate of 30 breaths/min (Choice D) are not typically associated with digoxin toxicity and do not require immediate intervention in the context of this question.

2. A client with a diagnosis of bipolar disorder is prescribed oxcarbazepine. The nurse should monitor for which potential adverse effect?

• A. Hyponatremia
• B. Agranulocytosis
• C. Liver toxicity
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A, Hyponatremia. Oxcarbazepine, an anticonvulsant used in bipolar disorder, can lead to hyponatremia. This is because it can cause the body to retain water, leading to a dilution of sodium levels in the blood. Monitoring sodium levels is crucial to prevent complications such as confusion, seizures, and even coma. Choices B, C, and D are incorrect. Agranulocytosis is not typically associated with oxcarbazepine use. Liver toxicity is a potential adverse effect of some medications but not commonly seen with oxcarbazepine. While weight gain can be a side effect of certain medications used in bipolar disorder treatment, it is not a common adverse effect of oxcarbazepine.

3. A client with a diagnosis of bipolar disorder is prescribed topiramate. The nurse should monitor for which potential adverse effect?

• A. Cognitive impairment
• B. Weight gain
• C. Liver toxicity
• D. Weight loss

Correct answer: A

Rationale: Correct. Topiramate is associated with cognitive impairment as an adverse effect. It is important for the nurse to monitor the client's cognitive function while on this medication to assess for any signs of cognitive decline or impairment. Choice B, weight gain, is incorrect as topiramate is actually associated with weight loss rather than weight gain. Choice C, liver toxicity, is also incorrect as topiramate is not known to cause liver toxicity. Choice D, weight loss, is not the correct answer as topiramate is not associated with weight gain.

4. A client with a history of heart failure is prescribed digoxin. The nurse should monitor for which potential side effect?

• A. Bradycardia
• B. Tachycardia
• C. Hypertension
• D. Hypotension

Correct answer: A

Rationale: Digoxin, a medication commonly prescribed for heart failure, can lead to bradycardia, characterized by a slow heart rate. Monitoring for bradycardia is crucial to detect and manage this potential side effect early on to prevent complications such as arrhythmias or decreased cardiac output. Tachycardia (choice B) is not typically associated with digoxin use. Hypertension (choice C) and hypotension (choice D) are also not common side effects of digoxin.

5. Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer's disease has been accomplished?

• A. Increased muscle strength and tone
• B. Fewer episodes of urinary incontinence
• C. Decreased confusion and improved mood
• D. Reversal of the disease process as evidenced by increased functioning

Correct answer: C

Rationale: The correct answer is C. Donepezil is a medication used for individuals with Alzheimer's disease. Its mechanism of action involves increasing acetylcholine levels by inhibiting its breakdown, which benefits cognitive function. The expected outcome of administering donepezil is a decrease in confusion and an improvement in mood due to the medication's impact on neurotransmitters. Choices A, B, and D are incorrect because donepezil does not primarily target muscle strength, urinary incontinence, or disease reversal; instead, it aims to slow down the progression of cognitive decline in Alzheimer's disease.

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