Nursing Elites

1. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A healthcare provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?

• A. 3 to 5 ng/mL
• B. 0.5 to 2 ng/mL
• C. 1.2 to 2.8 ng/mL
• D. 3.5 to 5.5 ng/mL

Correct answer: B

Rationale: The therapeutic serum level for digoxin ranges from 0.5 to 2 ng/mL. This range is considered optimal for therapeutic effects while minimizing the risk of toxicity. Levels above 2 ng/mL may lead to digoxin toxicity, which can manifest as anorexia among other symptoms. Therefore, the nurse should be vigilant in monitoring the digoxin levels to ensure the client's safety and therapeutic effectiveness of the medication.

2. A client presenting with complaints of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension, including a beta-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?

• A. Dyspnea, edema, and palpitations
• B. Chest pain, hypotension, and paresthesia
• C. Double vision, loss of appetite, and nausea
• D. Constipation, dry mouth, and sleep disorder

Correct answer: C

Rationale: The correct answer is C. Double vision, loss of appetite, and nausea are classic signs of digoxin toxicity. Other signs may include bradycardia, visual disturbances, and confusion. These symptoms are indicators that the client may be experiencing adverse effects due to elevated levels of digoxin in the system, requiring immediate medical attention to prevent serious complications.

3. A healthcare professional is planning to administer amlodipine (Norvasc) to a client. The healthcare professional plans to check which of the following before giving the medication?

• A. Respiratory rate
• B. Blood pressure and heart rate
• C. Heart rate and respiratory rate
• D. Level of consciousness and blood pressure

Correct answer: B

Rationale: Before administering amlodipine, it is important to check the client's blood pressure and heart rate. Amlodipine is known to lower blood pressure and heart rate as part of its mechanism of action. Monitoring these vital signs helps ensure the safety of the client and allows for appropriate assessment of the medication's effects post-administration.

4. Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:

• A. Increase DNA and RNA synthesis.
• B. Promote the biosynthesis of nucleic acids.
• C. Increase estrogen concentration and estrogen response.
• D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Correct answer: D

Rationale: The primary action of tamoxifen, an antineoplastic medication used in metastatic breast carcinoma, is to compete with estradiol for binding to estrogen receptors in tissues with high receptor concentrations. By doing so, tamoxifen reduces DNA synthesis and estrogen response, leading to its therapeutic effect in inhibiting the growth of estrogen-sensitive breast cancer cells.

5. The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following?

• A. I can skip a dose once a week.
• B. I need to change my position slowly.
• C. I take the pill after breakfast each day.
• D. If I get a bad headache, I should call my doctor immediately.

Correct answer: A

Rationale: Lisinopril should be taken daily as prescribed and not skipped. Skipping doses can lead to ineffective treatment.

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