Nursing Elites

1. A nurse is caring for a client who has heart failure and a prescription for furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

• A. Increased shortness of breath.
• B. Decreased peripheral edema.
• C. Increased jugular venous distention.
• D. Increased heart rate.

Correct answer: B

Rationale: The correct answer is B: Decreased peripheral edema. Furosemide is a diuretic that helps in reducing fluid overload in clients with heart failure by increasing urine output. A decrease in peripheral edema indicates that the medication is effectively removing excess fluid from the body. Choices A, C, and D are incorrect because they do not indicate an improvement in the client's condition. Increased shortness of breath, increased jugular venous distention, and increased heart rate are all signs of worsening heart failure and would not be expected findings when furosemide is effective.

2. A nurse is caring for a client who is receiving continuous cardiac monitoring. The client's heart rate is 69/min, and the PR interval is 0.24 seconds. What cardiac rhythm should the nurse interpret this finding as?

• A. First-degree AV block.
• B. Premature ventricular contraction.
• C. Sinus bradycardia.
• D. Atrial fibrillation.

Correct answer: A

Rationale: The correct answer is A: First-degree AV block. A PR interval of 0.24 seconds indicates a prolonged PR interval, which is characteristic of first-degree AV block. This rhythm is considered benign and often does not require treatment. Choice B, premature ventricular contraction, is characterized by early, abnormal ventricular contractions and would not be indicated by the findings provided. Choice C, sinus bradycardia, would present with a normal PR interval but a heart rate less than 60 beats per minute. Choice D, atrial fibrillation, is characterized by an irregularly irregular rhythm with no identifiable P waves, which does not align with the findings of a prolonged PR interval in this scenario.

3. A nurse is reviewing the medication record of a client with chronic kidney disease. Which of the following medications should the nurse question?

• A. Calcium carbonate
• B. Furosemide
• C. Epoetin alfa
• D. Spironolactone

Correct answer: D

Rationale: The correct answer is D, Spironolactone. Spironolactone is a potassium-sparing diuretic, which may lead to hyperkalemia in clients with chronic kidney disease. Therefore, its use should be questioned in this population. Choice A, Calcium carbonate, is commonly used to manage phosphate levels in chronic kidney disease. Choice B, Furosemide, is a loop diuretic that helps with fluid retention but should be used with caution in kidney disease. Choice C, Epoetin alfa, is a medication used to stimulate red blood cell production in clients with chronic kidney disease and anemia.

4. A client is postoperative following a total knee arthroplasty. Which of the following instructions should the nurse include in the discharge teaching?

• A. Cross your legs when sitting to prevent discomfort.
• B. Perform range-of-motion exercises every 4 hours.
• C. Wear compression stockings daily.
• D. Apply heat to the incision site daily.

Correct answer: C

Rationale: The correct answer is C: 'Wear compression stockings daily.' Wearing compression stockings is essential after knee surgery to prevent venous stasis and reduce the risk of blood clots. Choice A is incorrect as crossing legs when sitting can increase the risk of blood clots. Choice B is incorrect because performing range-of-motion exercises every 4 hours may not be suitable for all clients post total knee arthroplasty. Choice D is incorrect as applying heat to the incision site can increase the risk of infection.

5. A client has a new prescription for levothyroxine. Which of the following statements should the nurse include?

• A. Take this medication with food to prevent nausea.
• B. Take this medication in the morning to prevent insomnia.
• C. You should store this medication in the refrigerator.
• D. Take this medication with a full glass of water before breakfast.

Correct answer: D

Rationale: The correct statement the nurse should include is to take levothyroxine with a full glass of water before breakfast. This helps improve absorption and prevents gastrointestinal side effects. Choice A is incorrect because levothyroxine should be taken on an empty stomach. Choice B is incorrect as insomnia is not a common side effect of levothyroxine. Choice C is also incorrect as levothyroxine does not need to be refrigerated.

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