Nursing Elites

1. A healthcare professional in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for Digoxin toxicity?

• A. Calcium 9.2 mg/dL
• B. Calcium 10.3 mg/dL
• C. Potassium 3.4 mEq/L
• D. Potassium 4.8 mEq/L

Correct answer: C

Rationale: The correct answer is C: Potassium 3.4 mEq/L. Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium levels can lead to fatal dysrhythmias, especially in older clients taking Digoxin, as potassium plays a crucial role in the heart's electrical activity. Choices A and B are related to calcium levels, which do not directly increase the risk of Digoxin toxicity. Choice D, Potassium 4.8 mEq/L, is within the expected reference range and would not increase the risk of Digoxin toxicity.

2. A healthcare provider is preparing to administer dextrose 5% in water (D5W) 750 mL IV to infuse over 6 hr. How many mL/hr should the IV pump be set to deliver?

• A. 125 mL/hr
• B. 100 mL/hr
• C. 150 mL/hr
• D. 200 mL/hr

Correct answer: A

Rationale: To calculate the flow rate, divide the total volume by the total time: (750 mL / 6 hr) = 125 mL/hr. Therefore, the IV pump should be set to deliver 125 mL/hr to infuse dextrose 5% in water (D5W) over 6 hours. Choice B, 100 mL/hr, is incorrect as it does not match the correct calculation. Choice C, 150 mL/hr, is incorrect as it is higher than the calculated flow rate. Choice D, 200 mL/hr, is incorrect as it is also higher than the calculated flow rate.

3. A client has a new prescription for Furosemide. Which of the following instructions should be included?

• A. Take this medication at bedtime.
• B. Avoid eating foods high in potassium.
• C. Change positions slowly.
• D. Take this medication with meals.

Correct answer: C

Rationale: Furosemide is a diuretic that can lead to orthostatic hypotension, causing dizziness and falls. Instructing the client to change positions slowly helps prevent these adverse effects by allowing the body to adjust to postural changes gradually, reducing the risk of significant blood pressure drops upon standing up quickly.

4. A client is starting a new prescription for verapamil. Which of the following instructions should be included?

• A. Take the medication with a full glass of water.
• B. Avoid grapefruit juice.
• C. Monitor blood pressure regularly.
• D. Monitor heart rate daily.

Correct answer: B

Rationale: Clients prescribed verapamil should be advised to avoid grapefruit juice as it can potentiate the drug's effects, leading to adverse reactions. Grapefruit juice can inhibit the metabolism of verapamil, resulting in higher blood levels of the medication and an increased risk of side effects. Instructions such as taking the medication with a full glass of water (Choice A) are not specific to verapamil and are generally recommended. While monitoring blood pressure regularly (Choice C) is important for clients on antihypertensive medications, it is not a direct concern related to verapamil. Monitoring heart rate daily (Choice D) is not a primary consideration when starting verapamil, as it is more commonly used for its effects on blood pressure and arrhythmias rather than heart rate.

5. A healthcare provider is completing a client's medical history. The client takes Simvastatin. The healthcare provider should identify which of the following disorders as a contraindication to adding Ezetimibe to the client's medications?

• A. History of severe constipation
• B. History of hypertension
• C. Active hepatitis C
• D. Type 2 diabetes mellitus

Correct answer: C

Rationale: Ezetimibe is contraindicated in patients with active moderate-to-severe liver disorders, such as active hepatitis C, especially when they are already taking a statin like simvastatin. This combination can increase the risk of liver problems and is not recommended due to the potential for further liver damage. Choices A, B, and D are not directly contraindications for adding Ezetimibe to the client's medications.

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