Nursing Elites

1. A client with a diagnosis of heart failure is receiving digoxin (Lanoxin) and furosemide (Lasix). The LPN/LVN should closely monitor the client for which potential complication?

• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hyponatremia

Correct answer: B

Rationale: The correct answer is B: Hypokalemia. Furosemide is a loop diuretic that promotes the loss of potassium in the urine, potentially leading to hypokalemia. Hypokalemia increases the risk of digoxin toxicity, as digoxin's effects can be potentiated in the presence of low potassium levels. Monitoring for hypokalemia is crucial to prevent adverse effects and maintain the therapeutic effectiveness of digoxin in clients with heart failure. Choices A, C, and D are incorrect because furosemide does not typically cause hyperkalemia, hypernatremia, or hyponatremia. Instead, it commonly leads to hypokalemia due to increased potassium excretion.

2. The healthcare provider assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic?

• A. Tall, spiked T waves
• B. A prolonged QT interval
• C. A widening QRS complex
• D. Presence of a U wave

Correct answer: D

Rationale: The presence of a U wave is often associated with hypokalemia, a possible side effect of diuretic therapy like furosemide. Hypokalemia can lead to U wave formation on an electrocardiogram, making the presence of U waves a concerning finding in clients taking diuretics. Tall, spiked T waves are typically seen in hyperkalemia, not hypokalemia. A prolonged QT interval is more commonly associated with conditions like Long QT syndrome or certain medications, not specifically with diuretics. A widening QRS complex is usually seen in conditions affecting the conduction system of the heart, such as bundle branch blocks, rather than being directly related to diuretic use.

3. A healthcare professional is providing discharge teaching to a client who has a new prescription for enoxaparin. Which of the following instructions should the healthcare professional include?

• A. Administer the injection into the abdomen.
• B. Avoid massaging the injection site after administration.
• C. Expect mild bruising at the injection site.
• D. Avoid alternating injection sites between the arms.

Correct answer: A

Rationale: Administering enoxaparin into the abdomen is recommended to ensure proper absorption and effectiveness. Massaging the injection site after administration should be avoided as it can increase the risk of bleeding or bruising. Mild bruising at the injection site is common with enoxaparin and should be expected. Alternating injection sites, especially between arms, is not suitable for enoxaparin administration. Consistent administration into the abdomen is preferred for consistent absorption of the medication.

4. The nurse is caring for a client diagnosed with deep vein thrombosis (DVT). Which intervention should the nurse include in the client's plan of care to prevent the complication of pulmonary embolism?

• A. Encourage ambulation as tolerated.
• B. Administer anticoagulants as prescribed.
• C. Apply cold compresses to the affected area.
• D. Encourage the use of incentive spirometry.

Correct answer: B

Rationale: Administering anticoagulants as prescribed is crucial in preventing the complication of pulmonary embolism in clients with deep vein thrombosis. Anticoagulants help prevent the formation of new clots and the enlargement of existing ones, thereby reducing the risk of a pulmonary embolism. Encouraging ambulation as tolerated is beneficial for preventing complications related to immobility, but it is not the primary intervention to prevent pulmonary embolism in this case. Applying cold compresses to the affected area may help with pain and swelling but does not address the prevention of pulmonary embolism. Encouraging the use of incentive spirometry is more relevant in preventing respiratory complications such as atelectasis, not specifically pulmonary embolism.

5. The client is starting therapy with digoxin (Lanoxin). What instruction should the nurse reinforce about the medication?

• A. Take the medication with meals.
• B. Avoid dairy products.
• C. Monitor for yellow or blurred vision.
• D. Increase potassium-rich foods in the diet.

Correct answer: C

Rationale: The correct answer is C: 'Monitor for yellow or blurred vision.' When a client is taking digoxin, it is crucial to monitor for signs of toxicity, such as yellow or blurred vision, as these can indicate an adverse reaction. Reporting these visual disturbances promptly to the healthcare provider is important for further evaluation and management to prevent potential complications. Choices A, B, and D are incorrect because taking digoxin with meals, avoiding dairy products, or increasing potassium-rich foods are not specific instructions related to monitoring for adverse effects of digoxin therapy.

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