Nursing Elites

1. A client with heart failure is receiving digoxin (Lanoxin). Which finding indicates that the medication is effective?

• A. Increased heart rate.
• B. Decreased pedal edema.
• C. Elevated blood pressure.
• D. Improved urine output.

Correct answer: B

Rationale: In a client with heart failure, decreased pedal edema is a positive indicator of improved cardiac output and reduced fluid retention. Digoxin works by increasing the strength of the heart's contractions, leading to improved circulation and reduced symptoms of heart failure, such as edema. Monitoring for decreased pedal edema is essential to assess the effectiveness of digoxin therapy. Choices A, C, and D are incorrect because an increased heart rate, elevated blood pressure, and improved urine output are not specific indicators of digoxin's effectiveness in managing heart failure. Instead, the focus should be on improvements related to fluid retention and cardiac function, like decreased pedal edema.

2. What instruction should the nurse include in the discharge teaching for a patient with hypothyroidism prescribed levothyroxine?

• A. Take the medication with meals.
• B. Take the medication in the morning on an empty stomach.
• C. Discontinue the medication if you feel better.
• D. Double the dose if a dose is missed.

Correct answer: B

Rationale: The correct instruction for a patient with hypothyroidism prescribed levothyroxine is to take the medication in the morning on an empty stomach to enhance absorption. Taking it with meals can interfere with absorption. Patients should not discontinue the medication without consulting their healthcare provider as it can lead to adverse effects. Doubling the dose if a dose is missed can increase the risk of side effects and overdosage. It is crucial for patients to follow the prescribed dosing schedule and consult their healthcare provider for any concerns or missed doses.

3. A client with acute pancreatitis is admitted to the hospital. What is the priority nursing intervention for this client?

• A. Administering oral pancreatic enzymes
• B. Encouraging a high-protein diet
• C. Maintaining NPO status and administering IV fluids
• D. Providing a low-fat diet

Correct answer: C

Rationale: The priority nursing intervention for a client with acute pancreatitis is to maintain NPO (nothing by mouth) status and administer IV fluids. This approach helps rest the pancreas, decrease pancreatic stimulation, and prevent further exacerbation of the condition. By withholding oral intake and providing IV fluids, the pancreas is given the opportunity to recover and inflammation can be reduced. This intervention is crucial in the acute phase of pancreatitis to support the healing process and prevent complications.

4. A patient with depression is prescribed fluoxetine. What is an important side effect for the nurse to monitor?

• A. Weight gain
• B. Bradycardia
• C. Dry mouth
• D. Suicidal thoughts

Correct answer: D

Rationale: When a patient with depression is prescribed fluoxetine, the nurse should be vigilant for the potential side effect of increased risk of suicidal thoughts. Fluoxetine, like other antidepressants, may elevate the risk of suicidal thoughts, particularly during the initial phases of treatment. Monitoring the patient for any indications of heightened depression or suicidal ideation is crucial to ensure appropriate interventions are implemented promptly.

5. A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?

• A. The baby should be delivered immediately
• B. Symptoms will resolve promptly after delivery
• C. There is little risk of recurrence with subsequent pregnancies
• D. The mother should be screened for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency

Correct answer: B

Rationale: The patient's presentation is consistent with intrahepatic cholestasis of pregnancy (ICP), a condition characterized by elevated liver enzymes, pruritus, and jaundice in the absence of other liver disease causes. ICP typically resolves promptly after delivery. Immediate delivery is indicated only for fetal distress, not maternal symptoms. ICP does have a significant risk of recurrence in subsequent pregnancies. Treatment options for ICP include cholestyramine and ursodeoxycholic acid. Screening for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is not indicated in this context as it is associated with acute fatty liver of pregnancy and HELLP syndrome, not ICP.

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