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 is receiving continuous intravenous heparin for a deep vein thrombosis. Which laboratory result should the nurse monitor to ensure therapeutic heparin levels?

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

Correct answer: B

Rationale: The activated partial thromboplastin time (aPTT) is the most accurate measure of heparin's therapeutic effect. Heparin increases the time it takes for blood to clot, and the aPTT helps determine whether the dose is within the desired range for anticoagulation therapy. Monitoring the INR, hemoglobin, or platelet count is not specific to assessing therapeutic heparin levels and may not reflect the anticoagulant effect of heparin.

3. A client with Alzheimer's disease is prescribed donepezil. What is the most important teaching point?

• A. Take the medication as directed for best results.
• B. Report any unusual changes in behavior.
• C. This medication helps improve cognitive function.
• D. This medication is not a cure for Alzheimer's disease.

Correct answer: C

Rationale: The most important teaching point for a client prescribed donepezil is that it helps improve cognitive function. While it is important to take the medication as directed for best results (choice A) and report any unusual changes in behavior (choice B), the key point is that donepezil is not a cure for Alzheimer's disease (choice D). Therefore, the correct answer is C.

4. A client with heart failure is prescribed digoxin. What assessment finding should the nurse report immediately?

• A. Bradycardia of 50 beats per minute.
• B. Heart rate of 110 beats per minute.
• C. Respiratory rate of 16 breaths per minute.
• D. Blood pressure of 130/80 mmHg.

Correct answer: A

Rationale: The correct answer is A: Bradycardia of 50 beats per minute. Bradycardia is a critical assessment finding in a client prescribed with digoxin, as it can indicate digoxin toxicity. Bradycardia is a known side effect of digoxin, and if left unaddressed, it can lead to serious complications such as arrhythmias or cardiac arrest. Both choices B, heart rate of 110 beats per minute, and C, respiratory rate of 16 breaths per minute, fall within normal ranges and do not raise immediate concerns. Choice D, blood pressure of 130/80 mmHg, is also within normal limits and does not indicate digoxin toxicity. Therefore, the nurse should report bradycardia promptly to prevent further complications.

5. A client with acute pancreatitis is receiving intravenous fluids and pain medication. What is the priority assessment for this client?

• A. Monitor bowel sounds
• B. Measure urine output
• C. Assess for abdominal tenderness
• D. Monitor blood glucose levels

Correct answer: D

Rationale: The correct answer is D: Monitor blood glucose levels. Clients with acute pancreatitis are prone to hyperglycemia due to impaired insulin production. Monitoring blood glucose levels is crucial to prevent complications like diabetic ketoacidosis. While assessing bowel sounds, urine output, and abdominal tenderness are important in the overall care of a client with acute pancreatitis, monitoring blood glucose levels takes priority to address the immediate risk of hyperglycemia.

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