Nursing Elites

1. A client with congestive heart failure taking digoxin refused breakfast and is complaining of nausea and weakness. Which action should the nurse take first?

• A. Check the client's vital signs.
• B. Request a consult with a dietitian.
• C. Suggest that the client rests before eating the meal.
• D. Request an order for an antiemetic.

Correct answer: A

Rationale: The nurse should check the client's vital signs first because nausea and weakness can be signs of digoxin toxicity. Vital signs can provide immediate information on the client's condition and help guide further interventions. Monitoring vital signs will allow the nurse to assess for bradycardia, a common sign of digoxin toxicity. Requesting a dietitian consult (choice B) may be necessary but addressing the immediate concern of toxicity is the priority. Suggesting rest before eating (choice C) may not address the underlying issue of digoxin toxicity. Requesting an antiemetic (choice D) can be considered later but is not the initial action needed in this situation.

2. A client has a new prescription for Propranolol. Which of the following findings should the healthcare provider identify as a contraindication to this medication?

• A. Asthma
• B. Diabetes mellitus
• C. Hypertension
• D. Glaucoma

Correct answer: A

Rationale: Propranolol is a non-selective beta-blocker that can cause bronchoconstriction, making it contraindicated for clients with asthma. Asthma is a contraindication for Propranolol due to the potential of worsening bronchoconstriction and causing respiratory distress in individuals with this condition. Diabetes mellitus, hypertension, and glaucoma are not contraindications for Propranolol.

3. A client with a new prescription for an antihypertensive medication is being provided discharge instructions by a nurse. Which of the following statements should the nurse give?

• A. Be sure to limit your potassium intake while taking the medication.
• B. You should check your blood pressure every 8 hours while taking this medication.
• C. Your medication dosage will be increased if you develop tachycardia.
• D. Change positions slowly when you move from sitting to standing.

Correct answer: D

Rationale: The correct statement for the nurse to provide is to instruct the client to change positions slowly when moving from sitting to standing. This is crucial because antihypertensive medications can cause orthostatic hypotension, leading to dizziness or lightheadedness when changing positions quickly. Checking blood pressure every 8 hours is unnecessary and could lead to over-monitoring. There is no direct relationship between the medication and potassium intake. Increasing the medication dosage due to tachycardia is not a typical response and may not be accurate.

4. A client is starting therapy with Atenolol. Which of the following adverse effects should the nurse instruct the client to monitor?

• A. Tachycardia
• B. Hypoglycemia
• C. Bradycardia
• D. Hypertension

Correct answer: C

Rationale: Atenolol is a beta-blocker that can cause bradycardia as an adverse effect due to its mechanism of action in slowing down the heart rate. The nurse should instruct the client to monitor their pulse regularly and report any significant decreases to prevent complications related to bradycardia.

5. A client has a new prescription for a Nitroglycerin transdermal patch for Angina Pectoris. Which of the following instructions should the nurse include?

• A. Remove the patch each evening.
• B. Do not cut the patch in half even if angina attacks are under control.
• C. Take off the nitroglycerin patch if a headache occurs.
• D. Apply a new patch every 48 hours.

Correct answer: A

Rationale: The correct instruction is to remove the nitroglycerin patch each evening to prevent tolerance. This allows for a 10- to 12-hour nitrate-free period daily, reducing the risk of developing tolerance to nitroglycerin. Cutting the patch in half is not recommended because it can alter the dosing and absorption rate, leading to inadequate symptom control. Taking off the patch for a headache is not necessary as headaches are a common side effect that may improve with continued use. Applying a new patch every 48 hours is not correct as it may not provide continuous symptom relief for angina.

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