a nurse is assessing a client who has a new prescription for digoxin which of the following findings is the priority for the nurse to report to the pr

ATI RN

ATI RN Exit Exam Test Bank

1. A healthcare professional is assessing a client who has a new prescription for digoxin. Which of the following findings is the priority for the healthcare professional to report to the provider?

A. Heart rate of 58/min
B. Weight gain of 1 kg (2.2 lb) in 24 hours
C. Respiratory rate of 20/min
D. Temperature of 37.3°C (99.1°F)

Correct answer: A

Rationale: The correct answer is A. A heart rate of 58/min is indicative of bradycardia, a potential sign of digoxin toxicity, which should be reported immediately. While weight gain, respiratory rate, and temperature are important parameters to monitor, they are not as critical as identifying bradycardia in a client taking digoxin.

2. How should fluid balance be assessed in a patient receiving diuretics?

A. Monitor daily weight
B. Monitor intake and output
C. Check for edema
D. Monitor blood pressure

Correct answer: A

Rationale: Corrected Rationale: Monitoring daily weight is the most accurate method to assess fluid balance in patients receiving diuretics. Changes in weight reflect changes in fluid balance, making it a sensitive indicator. Monitoring intake and output (choice B) is important but may not provide a complete picture of overall fluid balance. Checking for edema (choice C) is a late sign of fluid imbalance and may not be sensitive enough to detect subtle changes. Monitoring blood pressure (choice D) is relevant but may not directly reflect fluid balance as it can be influenced by various other factors.

3. Which lab value is most critical to monitor in a patient receiving digoxin?

A. Monitor potassium levels
B. Monitor sodium levels
C. Monitor calcium levels
D. Monitor magnesium levels

Correct answer: A

Rationale: The correct answer is to monitor potassium levels in a patient receiving digoxin. Hypokalemia can potentiate the toxic effects of digoxin, leading to serious cardiac arrhythmias. Monitoring potassium levels helps prevent toxicity. Monitoring sodium levels (Choice B), calcium levels (Choice C), and magnesium levels (Choice D) are also important aspects of patient care, but potassium levels are most critical in patients on digoxin therapy.

4. A nurse in a pediatric clinic is reviewing the laboratory test results of a school-age child. Which of the following findings should the nurse report to the provider?

A. Hgb 12.5 g/dL.
B. Platelets 250,000/mm³.
C. Hct 40%.
D. WBC 14,000/mm³.

Correct answer: D

Rationale: The correct answer is D. A WBC count of 14,000/mm³ is elevated, indicating a potential infection or inflammation, and should be reported to the provider for further evaluation and management. Choices A, B, and C are within normal ranges and do not require immediate reporting as they indicate normal hemoglobin, platelet count, and hematocrit levels for a school-age child.

5. A nurse is caring for a client who is in labor and requires augmentation of labor. Which of the following conditions should the nurse recognize as a contraindication to the use of oxytocin?

A. Diabetes mellitus
B. Shoulder presentation
C. Postterm with oligohydramnios
D. Chorioamnionitis

Correct answer: B

Rationale: Shoulder presentation is a contraindication for oxytocin because it can increase the risk of complications during labor, such as shoulder dystocia. Diabetes mellitus (Choice A) is not a contraindication for the use of oxytocin. Postterm with oligohydramnios (Choice C) and chorioamnionitis (Choice D) may actually necessitate the use of oxytocin to induce or augment labor for the well-being of the mother and baby.