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 chronic kidney disease is prescribed sevelamer carbonate. The nurse should monitor for which potential side effect?

• A. Hypercalcemia
• B. Hypocalcemia
• C. Hyperkalemia
• D. Hypokalemia

Correct answer: A

Rationale: When a client with chronic kidney disease is prescribed sevelamer carbonate, the nurse should monitor for hypercalcemia as a potential side effect. Sevelamer carbonate can bind to dietary calcium and impair its absorption, potentially leading to elevated calcium levels in the blood. Monitoring calcium levels is crucial to detect and manage hypercalcemia promptly. Hypocalcemia (choice B) is incorrect because sevelamer carbonate's action is more likely to cause elevated calcium levels. Hyperkalemia (choice C) and hypokalemia (choice D) are related to potassium levels and are not typically associated with sevelamer carbonate use.

3. The healthcare provider is evaluating the effectiveness of metaproterenol for how do you know it's been effective?

• A. Increased heart rate and blood pressure
• B. Decreased white blood cell count
• C. Decreased wheezing upon auscultation
• D. Decreased respiratory rate

Correct answer: C

Rationale: The effectiveness of metaproterenol, a bronchodilator, is assessed by a decrease in wheezing upon auscultation. Wheezing indicates airway constriction, and a reduction in wheezing signifies improved airflow and bronchodilation due to the medication's action. Therefore, choices A, B, and D are incorrect as they do not directly relate to the expected outcome of metaproterenol therapy.

4. A client with a diagnosis of schizophrenia is prescribed ziprasidone. The nurse should monitor the client for which potential side effect?

• A. QT prolongation
• B. Weight gain
• C. Dry mouth
• D. Increased appetite

Correct answer: A

Rationale: The correct answer is A: QT prolongation. Ziprasidone is known to cause QT prolongation, which can potentially lead to serious cardiac issues. Monitoring the client's ECG is crucial to detect any changes and prevent adverse effects related to QT interval prolongation. Choices B, C, and D are incorrect because weight gain, dry mouth, and increased appetite are not commonly associated with ziprasidone. While weight gain can be a side effect of some antipsychotic medications, it is not a prominent side effect of ziprasidone. Dry mouth and increased appetite are also not typically linked to ziprasidone use.

5. When educating a client about the adverse effects of conjunctivitis, what is a serious condition that requires prompt attention?

• A. Contact lens irritation
• B. Decreased sex drive
• C. Brown spots on the skin
• D. Epigastric pain unrelieved by antacids

Correct answer: D

Rationale: Epigastric pain unrelieved by antacids is a concerning symptom that may indicate a more serious underlying condition such as a perforated ulcer. This symptom requires immediate medical attention to prevent further complications.

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