Nursing Elites

1. A client with a history of heart failure is prescribed spironolactone. The nurse should monitor for which potential side effect?

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

Correct answer: A

Rationale: The correct answer is A: Hyperkalemia. Spironolactone is a potassium-sparing diuretic, which can lead to an excess of potassium in the body, causing hyperkalemia. This medication inhibits the action of aldosterone, leading to decreased potassium excretion and potential retention. Monitoring potassium levels is essential to prevent complications such as cardiac arrhythmias, especially in clients with heart failure.

2. After receiving the third dose of a new oral anticoagulant prescription, which action should the nurse implement? Select all that apply.

• A. Notify the healthcare provider of the finding
• B. Provide a PRN NSAID for gum discomfort
• C. Review the most recent coagulation lab values
• D. Complete a medication variance report

Correct answer: C

Rationale: Reviewing the most recent coagulation lab values is crucial after receiving multiple doses of a new oral anticoagulant to ensure the patient is within the desired therapeutic range and to prevent adverse events related to over or under-anticoagulation. It is essential to monitor these values closely to adjust the dosage if needed. Notifying the healthcare provider of any concerning findings is important, but it may not be the immediate priority after receiving the third dose. Providing a PRN NSAID for gum discomfort is not typically indicated with oral anticoagulant therapy, as it may increase the risk of bleeding. Completing a medication variance report is more relevant in cases of medication errors or discrepancies, which may not apply in this scenario.

3. A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse reinforce in this client's teaching?

• A. Discontinue the medication if dizziness occurs.
• B. Avoid getting up quickly. Always rise slowly.
• C. Take the medication with or without food.
• D. Increase your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct instruction that the practical nurse should reinforce with a client prescribed nitrate isosorbide dinitrate is to avoid getting up quickly and to rise slowly. Nitrates can cause orthostatic hypotension, a sudden drop in blood pressure when changing positions. By rising slowly, the client can prevent the occurrence of orthostatic hypotension and its associated symptoms. Choices A, C, and D are incorrect because discontinuing the medication without consulting a healthcare provider can be dangerous, taking the medication with or without food does not impact its effectiveness, and increasing potassium intake is not directly related to the use of nitrate isosorbide dinitrate.

4. A client with chronic heart failure is prescribed furosemide. The nurse should monitor the client for which potential adverse effect?

• A. Increased blood glucose levels
• B. Electrolyte imbalance
• C. Dehydration
• D. Weight gain

Correct answer: C

Rationale: When a client with chronic heart failure is prescribed furosemide, a diuretic, the nurse should be vigilant for potential adverse effects. Furosemide can lead to excessive fluid loss, resulting in dehydration. Dehydration is a significant concern as it can exacerbate heart failure symptoms. Additionally, furosemide can cause electrolyte imbalances, particularly affecting potassium and sodium levels. Monitoring for signs of dehydration and electrolyte disturbances is crucial to prevent complications and ensure the client's safety and well-being. Increased blood glucose levels and weight gain are not commonly associated with furosemide use in heart failure patients, making choices A and D incorrect.

5. A client with severe rheumatoid arthritis is prescribed infliximab. The nurse should monitor for which potential adverse effect?

• A. Increased risk of infection
• B. Bone marrow suppression
• C. Hair loss
• D. Pancreatitis

Correct answer: A

Rationale: The correct answer is A: Increased risk of infection. Infliximab is known to increase the risk of infection due to its immunosuppressive effects. It is crucial for the nurse to monitor for signs of infection in the client receiving infliximab to promptly address any potential complications and ensure the client's safety and well-being. Choices B, C, and D are incorrect because bone marrow suppression, hair loss, and pancreatitis are not typically associated with infliximab therapy. While these adverse effects can occur with other medications, the primary concern with infliximab is the increased risk of infection.

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