Nursing Elites

1. A client with heart failure is prescribed digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse teach the client to report?

• A. Increased appetite.
• B. Yellow or blurred vision.
• C. Weight gain.
• D. Nasal congestion.

Correct answer: B

Rationale: Yellow or blurred vision is a hallmark sign of digoxin toxicity. Digoxin toxicity can affect various body systems, but visual disturbances, such as yellow or blurred vision, are important signs that the client should report immediately. Other signs like increased appetite, weight gain, or nasal congestion are not typically associated with digoxin toxicity. Prompt reporting of visual disturbances can help prevent further complications associated with digoxin toxicity.

2. A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?

• A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
• B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
• C. Sucralfate is not the drug of choice for prophylaxis in this patient.
• D. H. pylori infection can alter the risk for an NSAID-induced ulcer.

Correct answer: B

Rationale: In this scenario, the patient's history of peptic ulcer disease puts her at risk for NSAID-related GI toxicity. Misoprostol and proton-pump inhibitors have shown superiority over H2-blockers in preventing NSAID-related GI toxicity. H. pylori infection can indeed increase the risk of an NSAID-induced ulcer in infected patients who are starting NSAID therapy. Sucralfate has not been proven to be effective in prophylaxis against NSAID-related GI toxicity. Therefore, the correct choice is B, as misoprostol is the preferred option over an H2-blocker in this context.

3. The healthcare professional is caring for a client with heart failure who is receiving digoxin (Lanoxin). Which assessment finding requires immediate intervention?

• A. Heart rate of 58 beats per minute.
• B. Nausea and vomiting.
• C. Blood pressure of 130/80 mm Hg.
• D. Shortness of breath.

Correct answer: B

Rationale: The correct answer is B. Nausea and vomiting are common signs of digoxin toxicity, which can lead to serious complications like dysrhythmias. Prompt intervention is crucial to prevent further harm to the client. Choice A, a heart rate of 58 beats per minute, although slightly lower than normal, may be appropriate for a client on digoxin. Choice C, a blood pressure of 130/80 mm Hg, is within normal limits and does not indicate an immediate need for intervention. Choice D, shortness of breath, is a common symptom in heart failure and requires monitoring but is not as indicative of digoxin toxicity as nausea and vomiting.

4. The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?

• A. Hemoglobin level of 12 g/dL.
• B. Platelet count of 150,000/mm3.
• C. White blood cell count of 2,000/mm3.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: C

Rationale: A white blood cell count of 2,000/mm3 is low and indicates leukopenia, which increases the client's risk for infection. Hemoglobin level and platelet count are not directly indicative of infection risk. Serum creatinine level is related to kidney function, not infection risk.

5. When planning care for a 16-year-old with appendicitis presenting with right lower quadrant pain, what should the nurse prioritize as a nursing diagnosis?

• A. Imbalanced nutrition: Less than body requirements related to decreased oral intake
• B. Risk for infection related to possible rupture of the appendix
• C. Constipation related to decreased bowel motility and decreased fluid intake
• D. Chronic pain related to appendicitis

Correct answer: B

Rationale: The priority nursing diagnosis for a client with appendicitis is the 'Risk for infection related to possible rupture of the appendix.' Appendicitis carries a risk of the appendix rupturing, which can lead to peritonitis, a life-threatening condition. Preventing infection through timely intervention and surgery is critical in the care of a client with appendicitis, making this nursing diagnosis the priority.

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