Nursing Elites

1. A client is admitted to the emergency department with a suspected myocardial infarction (MI). The nurse should prepare the client for which immediate diagnostic test?

• A. Chest x-ray
• B. Electrocardiogram (ECG)
• C. Echocardiogram
• D. Coronary angiography

Correct answer: B

Rationale: An Electrocardiogram (ECG) is the most immediate and essential test to diagnose a myocardial infarction (MI) and assess the extent of heart damage. An ECG can quickly identify changes in the heart's electrical activity, allowing prompt initiation of appropriate interventions. A chest x-ray (Choice A) may show other conditions affecting the heart, but it is not the immediate test of choice for diagnosing an MI. An echocardiogram (Choice C) and coronary angiography (Choice D) are valuable in further assessing cardiac function and anatomy post-MI but are not the first-line diagnostic tests due to their time-consuming nature compared to an ECG.

2. A client has a new prescription for heparin. Which of the following laboratory results should be monitored to evaluate the effectiveness of the medication?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Platelet count

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory result that should be monitored to evaluate the effectiveness of heparin. Heparin works by prolonging the aPTT, and monitoring this parameter helps ensure the medication's effectiveness and safety in preventing clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor the effectiveness of warfarin, another anticoagulant. Platelet count is essential to assess platelet function and clotting disorders, but it is not specifically used to monitor heparin therapy.

3. A client who has been taking prednisone is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

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

Correct answer: B

Rationale: Hyperglycemia is a significant finding in a client taking prednisone as it indicates the medication's impact on glucose metabolism. Prednisone can lead to increased blood sugar levels, which can be detrimental, especially in clients with diabetes or predisposition to hyperglycemia. Reporting hyperglycemia promptly to the healthcare provider is crucial for further evaluation and management to prevent complications. Choices A, C, and D are common side effects of prednisone but are not as concerning as hyperglycemia, which requires immediate attention to avoid potential adverse effects.

4. A client with chronic heart failure is being discharged with a prescription for digoxin (Lanoxin). Which instruction should the nurse reinforce?

• A. Take the medication at the same time each day.
• B. Avoid foods high in potassium.
• C. Skip a dose if you feel well.
• D. Take the medication on an empty stomach.

Correct answer: A

Rationale: Taking digoxin at the same time each day is essential to maintain a consistent blood level of the medication. This consistency helps optimize the therapeutic effects of digoxin in managing chronic heart failure. Deviating from the scheduled time could lead to fluctuations in drug levels, affecting its effectiveness and potentially causing harm. Choices B, C, and D are incorrect because avoiding potassium-rich foods, skipping doses when feeling well, and taking the medication on an empty stomach are not relevant or appropriate instructions for a client prescribed digoxin.

5. A client with heart failure is prescribed an angiotensin-converting enzyme (ACE) inhibitor. What instruction should the nurse reinforce to the client?

• A. Take the medication at bedtime.
• B. Report a persistent dry cough.
• C. Increase potassium-rich foods in the diet.
• D. Avoid taking the medication with meals.

Correct answer: B

Rationale: The correct answer is B. A persistent dry cough is a common side effect of ACE inhibitors and should be reported to the healthcare provider. This symptom can indicate a potential issue with the medication that may require adjustment or discontinuation. Choices A, C, and D are incorrect. Taking the medication at bedtime or with meals is not a specific instruction for ACE inhibitors. Increasing potassium-rich foods in the diet is not directly related to ACE inhibitor therapy and may not be suitable for all patients.

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