Nursing Elites

1. A client with cirrhosis is prescribed spironolactone to manage ascites. Which serum laboratory value is most important for the nurse to monitor?

• A. Sodium
• B. Calcium
• C. Magnesium
• D. Potassium

Correct answer: D

Rationale: The correct answer is D: Potassium. Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia. Monitoring potassium levels is crucial to prevent complications like cardiac arrhythmias. Choices A, B, and C are incorrect because sodium, calcium, and magnesium levels are not directly affected by spironolactone use for managing ascites in cirrhosis.

2. A client has been receiving hydromorphone every six hours for four days. What assessment should the nurse prioritize?

• A. Increase the dosage of the medication.
• B. Auscultate bowel sounds.
• C. Monitor the client's blood pressure.
• D. Check the client's respiratory rate.

Correct answer: B

Rationale: The correct answer is B. Hydromorphone can cause constipation, a common side effect of opioids. Therefore, it is crucial to auscultate bowel sounds to monitor for signs of decreased gastrointestinal motility. Monitoring blood pressure (choice C) and respiratory rate (choice D) are important but not the priority in this scenario as constipation is a common issue with opioid use. Increasing the dosage of the medication (choice A) is not appropriate without assessing the client's bowel function first.

3. A client is newly prescribed lithium for bipolar disorder. Which finding is most important to report to the healthcare provider?

• A. A serum lithium level of 1.2 mEq/L.
• B. Fine hand tremors noted after starting the medication.
• C. A blood pressure of 110/60 mmHg.
• D. A serum sodium level of 140 mEq/L.

Correct answer: B

Rationale: The correct answer is B. Fine hand tremors noted after starting lithium are an early sign of lithium toxicity. It is crucial to report this finding to the healthcare provider promptly. Adjusting the dose or monitoring serum levels more closely may be necessary to prevent further toxicity. Choice A, a serum lithium level of 1.2 mEq/L, is within the therapeutic range (0.6-1.2 mEq/L) for treating bipolar disorder. Choice C, a blood pressure of 110/60 mmHg, and Choice D, a serum sodium level of 140 mEq/L, are within normal limits and not directly related to lithium therapy or toxicity.

4. A client with congestive heart failure is prescribed digoxin. What symptom indicates digoxin toxicity?

• A. Monitor for muscle weakness and fatigue.
• B. Monitor for increased appetite and weight gain.
• C. Monitor for nausea and vomiting.
• D. Monitor for blurred vision or seeing yellow halos around objects.

Correct answer: D

Rationale: Corrected Rationale: Blurred vision or seeing yellow halos around objects are signs of digoxin toxicity, which can be life-threatening. These symptoms indicate an overdose of digoxin, requiring immediate medical attention. Muscle weakness and fatigue (Choice A) are not typically associated with digoxin toxicity. Increased appetite and weight gain (Choice B) are not indicative of digoxin toxicity either. Nausea and vomiting (Choice C) are common side effects of digoxin but are not specific signs of toxicity. Therefore, the correct answer is to monitor for blurred vision or seeing yellow halos around objects.

5. What does the nurse's signature on the client’s surgical consent form signify?

• A. The client voluntarily grants permission for the procedure to be done
• B. The client is competent to sign the consent without impairment of judgment
• C. The client understands the risks and benefits associated with the procedure
• D. The client has signed the form freely and voluntarily

Correct answer: A

Rationale: The nurse's signature on a surgical consent form signifies that the client voluntarily grants permission for the procedure to be done. This is the correct answer because the nurse's signature does not imply the client's competence, understanding of risks and benefits, or that the client signed the form freely and voluntarily. The nurse's role is to verify that the client has made an informed decision and is providing consent for the procedure.

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