Nursing Elites

1. A female patient is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and her heart 'flutters' frequently. What action should the nurse take?

• A. Tell the patient to rest more frequently.
• B. Advise the patient to discontinue digoxin and contact the physician.
• C. Contact the physician, report the symptoms, and request a blood sample to determine the patient's potassium level.
• D. Instruct the patient to avoid caffeine-containing foods.

Correct answer: C

Rationale: The correct action for the nurse to take is to contact the physician, report the patient's symptoms, and request a blood sample to determine the patient's potassium level. Furosemide, a potassium-wasting diuretic, can lead to hypokalemia, causing weakness and palpitations. Therefore, checking the potassium level is crucial in this situation. Simply telling the patient to rest more frequently won't address the underlying issue of potassium depletion. While digoxin can cause adverse effects, in this case, the symptoms are more likely related to furosemide-induced potassium loss. Instructing the patient to avoid caffeine-containing foods may be beneficial in general, but it wouldn't directly address the potassium depletion that needs urgent attention.

2. A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?

• A. Depth of respirations
• B. Bowel sounds
• C. Grip strength
• D. Electrocardiography

Correct answer: Depth of respirations

Rationale: The correct answer is 'Depth of respirations.' In a client with electrolyte imbalances like low potassium (hypokalemia) and low magnesium (hypomagnesemia), respiratory changes, such as shallow respirations or respiratory muscle weakness, can occur and lead to respiratory compromise. Assessing the depth of respirations is crucial to evaluate respiratory function in this client. Bowel sounds, grip strength, and electrocardiography are also important assessments in different situations, but in this case, respiratory assessment takes priority due to the potential impact of electrolyte imbalances on breathing.

3. The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate?

• A. Hypermagnesemia
• B. Hypomagnesemia
• C. Hypocalcemia
• D. Hyperkalemia

Correct answer: C

Rationale: Chvostek's sign is characterized by a brief contraction of the upper lip, nose, or side of the face and is indicative of hypocalcemia, making choice C the correct answer. Hypomagnesemia (choice B) is associated with Trousseau's sign, not Chvostek's sign. Hypermagnesemia (choice A) is not related to Chvostek's sign. Hyperkalemia (choice D) is not typically associated with Chvostek's sign; instead, it may present with muscle weakness and cardiac arrhythmias.

4. What is the fluid that surrounds the cells called?

• A. plasma
• B. interstitial fluid
• C. intracellular fluid
• D. edema

Correct answer: B

Rationale: The correct answer is interstitial fluid. Interstitial fluid is the fluid that surrounds and fills the spaces between cells, facilitating nutrient and waste exchange. Plasma, referred to in choice A, is the liquid part of blood. Choice C, intracellular fluid, is the fluid inside cells. Choice D, edema, is an abnormal accumulation of fluid in interstitial spaces, causing swelling.

5. You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that do not apply

• A. Milk
• B. Beef
• C. Poultry
• D. Liver

Correct answer: Beef

Rationale:

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