Nursing Elites

1. A client has been prescribed a calcium channel blocker for angina. The nurse knows this medication should NOT be used with caution in combination with which drug classes?

• A. NSAIDs
• B. Cardiac glycosides
• C. Beta blockers
• D. None of the above

Correct answer: C

Rationale: Calcium channel blockers and beta blockers should be used with caution together because they can both suppress heart function, potentially leading to bradycardia, heart block, or heart failure. NSAIDs and cardiac glycosides do not have significant interactions with calcium channel blockers in the same way, so they are not typically a cause for concern when combined.

2. A client is prescribed Diltiazem. Which of the following findings should the nurse monitor?

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

Correct answer: B

Rationale: Diltiazem is a calcium channel blocker that can lead to bradycardia as an adverse effect due to its negative chronotropic and dromotropic effects on the heart. The nurse should monitor the client's heart rate regularly to detect any signs of bradycardia and take appropriate actions if necessary. Tachycardia (Choice A) is not an expected finding with Diltiazem use. Hypertension (Choice C) is actually a condition that Diltiazem is used to treat. Hyperkalemia (Choice D) is not a common adverse effect of Diltiazem.

3. A healthcare provider in a clinic is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for Digoxin toxicity?

• A. Calcium 9.2 mg/dL
• B. Calcium 10.3 mg/dL
• C. Potassium 3.4 mEq/L
• D. Potassium 4.8 mEq/L

Correct answer: C

Rationale: Potassium 3.4 mEq/L is below the expected reference range, which increases the risk for digoxin toxicity. Low potassium levels can lead to fatal dysrhythmias, particularly in older clients taking Digoxin. Hypokalemia potentiates the effects of Digoxin, making the heart more sensitive to its toxic effects. Monitoring and correcting electrolyte imbalances, especially low potassium levels, are crucial to prevent adverse effects of digoxin therapy. Calcium levels do not directly influence digoxin toxicity, so choices A and B are incorrect. High potassium levels, as in choice D, are less likely to increase the risk of digoxin toxicity compared to low potassium levels.

4. A client has a new prescription for Atorvastatin. Which of the following instructions should the nurse include?

• A. Avoid drinking grapefruit juice.
• B. Take the medication with your evening meal.
• C. Increase your intake of leafy green vegetables.
• D. Stop taking the medication if you experience muscle pain.

Correct answer: A

Rationale: The correct answer is A: 'Avoid drinking grapefruit juice.' Grapefruit juice should be avoided when taking Atorvastatin because it can increase the blood levels of the medication, potentially leading to a higher risk of adverse effects like muscle pain and liver damage. It is important to follow this instruction to ensure the safe and effective use of Atorvastatin. Choices B, C, and D are incorrect. Taking Atorvastatin with food, specifically a low-fat meal, is recommended, but it is not necessary to specify the evening meal. While increasing intake of leafy green vegetables is generally beneficial for health, it is not a specific instruction for Atorvastatin. Lastly, stopping the medication if one experiences muscle pain is not advisable without consulting a healthcare provider, as muscle pain can be a symptom of a serious side effect of Atorvastatin that requires medical attention.

5. Which of the following is not directly related to drug toxicity of Nitroglycerin?

• A. Headaches
• B. Tachycardia
• C. Dizziness
• D. Projectile vomiting

Correct answer: D

Rationale: Headaches, tachycardia, and dizziness are common side effects of nitroglycerin due to its vasodilatory properties. Projectile vomiting is not typically associated with nitroglycerin toxicity, making it the correct answer. Therefore, option D is the correct choice.

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