a nurse is caring for a client who has heart failure and is receiving a continuous iv infusion of milrinone which of the following actions should the a nurse is caring for a client who has heart failure and is receiving a continuous iv infusion of milrinone which of the following actions should the
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Nursing Elites

ATI RN

ATI Comprehensive Exit Exam

1. A client with heart failure is receiving a continuous IV infusion of milrinone. Which of the following actions should the nurse take?

Correct answer: D

Rationale: Measuring the client's intake and output every 2 hours is essential when caring for a client receiving a continuous IV infusion of milrinone. Milrinone is a medication that affects fluid balance, and monitoring intake and output helps assess the client's response to the medication. Continuous monitoring of blood pressure may not be necessary unless there is a specific indication. While weighing the client daily is important for overall assessment, measuring intake and output more frequently provides more real-time data for fluid balance evaluation. Monitoring the infusion site is crucial for detecting infiltration but is not directly related to managing fluid balance in this situation.

2. A nurse is caring for a client taking ciprofloxacin for an infection. Which of the following adverse effects should the nurse include in the client education?

Correct answer: B

Rationale: The correct answer is B: Tendon rupture. Ciprofloxacin belongs to the fluoroquinolone class of antibiotics, which is associated with the adverse effect of tendon rupture. Tendon rupture is a severe but rare side effect that can occur with the use of ciprofloxacin. Educating the client about this potential adverse effect is crucial to promote awareness and early recognition of symptoms, such as tendon pain, swelling, or inflammation. Choices A, C, and D are not typically associated with ciprofloxacin use and are less relevant for client education in this scenario.

3. A healthcare professional is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptom shouldn't the healthcare professional expect?

Correct answer: C

Rationale: Palpitations are not typically associated with moderate anxiety. Fidgeting, laughing inappropriately, and nail biting are common behavioral symptoms of heightened stress levels. Palpitations may be more indicative of physiological responses, such as increased heart rate, which can occur in severe anxiety or panic attacks. Other signs of severe anxiety include restlessness, difficulty concentrating, muscle tension, and sleep disturbances.

4. Why is a beta-blocker prescribed to a client with a history of myocardial infarction?

Correct answer: A

Rationale: The primary reason for administering a beta-blocker to a client with a history of myocardial infarction is to reduce myocardial oxygen demand. By reducing myocardial oxygen demand, beta-blockers help decrease the workload on the heart, making it easier for the heart to function effectively. This is crucial for clients with a history of myocardial infarction to prevent further damage to the heart. Choice B is incorrect because beta-blockers do not aim to increase cardiac output; instead, they help improve cardiac function by reducing workload. Choice C is incorrect because while beta-blockers can help prevent certain arrhythmias, the primary reason for their use in this case is to reduce myocardial oxygen demand. Choice D is incorrect as preventing angina is not the primary purpose of administering beta-blockers to a client with a history of myocardial infarction.

5. Which vitamin is primarily obtained from sunlight exposure?

Correct answer: C

Rationale: The correct answer is Vitamin D. Vitamin D is synthesized in the skin when it is exposed to sunlight. This process allows the body to produce Vitamin D naturally. Vitamin A (Choice A) is found in foods like liver and carrots and is not primarily obtained from sunlight. Vitamin C (Choice B) is commonly found in fruits and vegetables. Vitamin E (Choice D) is present in foods like nuts and seeds and is not primarily obtained from sunlight.

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