Nursing Elites

1. A nurse is preparing to administer a dose of digoxin to a client who has heart failure. Which of the following actions should the nurse take prior to administering the medication?

• A. Monitor the client's respiratory rate.
• B. Assess the client's apical pulse.
• C. Review the client's potassium level.
• D. Monitor the client's fluid intake.

Correct answer: B

Rationale: The correct action the nurse should take prior to administering digoxin is to assess the client's apical pulse. Digoxin is known to affect the heart rate, potentially causing bradycardia. Monitoring the client's respiratory rate (Choice A) is not directly related to administering digoxin. Reviewing the client's potassium level (Choice C) is important but not a direct prerequisite for administering digoxin. Monitoring the client's fluid intake (Choice D) is also important but not a specific action to take just before administering digoxin.

2. A client is receiving a new prescription for enoxaparin. Which of the following instructions should the nurse include?

• A. Rub the injection site after administration.
• B. Pinch the skin while administering the injection.
• C. Aspirate before administering the medication.
• D. Avoid taking aspirin while using this medication.

Correct answer: D

Rationale: The correct answer is D: 'Avoid taking aspirin while using this medication.' Enoxaparin is an anticoagulant medication, and taking aspirin concurrently can increase the risk of bleeding. Choices A, B, and C are incorrect. A nurse should not instruct the client to rub the injection site after administration as it may cause irritation. Pinching the skin while administering the injection is not recommended for enoxaparin injections. Aspirating before administering the medication is also unnecessary as enoxaparin is administered subcutaneously, not intramuscularly.

3. A nurse is assessing a client who has schizophrenia and is taking chlorpromazine. Which of the following findings should the nurse identify as an adverse effect of the medication?

• A. Weight gain
• B. Dry mouth
• C. Sedation
• D. Diarrhea

Correct answer: C

Rationale: The correct answer is C: Sedation. Chlorpromazine, an antipsychotic medication, commonly causes sedation as an adverse effect. Weight gain (choice A) is a potential side effect of some antipsychotic medications, but it is not specifically associated with chlorpromazine. Dry mouth (choice B) is a common anticholinergic side effect of many medications but is not a prominent adverse effect of chlorpromazine. Diarrhea (choice D) is not a typical adverse effect of chlorpromazine.

4. A healthcare provider is providing dietary teaching to a client who has a new diagnosis of hypertension. Which of the following foods should the provider recommend?

• A. Bananas
• B. Whole grains
• C. Lean beef
• D. Canned soup

Correct answer: C

Rationale: The correct answer is lean beef because it is a good source of protein and essential nutrients. When providing dietary recommendations to clients with hypertension, it is important to focus on lean protein sources to promote a balanced diet. Bananas, although a healthy fruit, may not be the best choice due to their high potassium content, which can sometimes be a concern for individuals with hypertension. Whole grains are generally a good choice, but lean protein like beef is more suitable in this scenario. Canned soup often contains high levels of sodium, which is not recommended for individuals with hypertension.

5. A nurse is caring for a client who has a prescription for warfarin. Which of the following laboratory values should the nurse monitor?

• A. Prothrombin time (PT)
• B. Hemoglobin
• C. aPTT
• D. INR

Correct answer: D

Rationale: The correct answer is D, INR. The International Normalized Ratio (INR) is used to monitor the therapeutic effect of warfarin and to adjust the dose as needed. While Prothrombin time (PT) and activated Partial Thromboplastin Time (aPTT) are also related to coagulation studies, monitoring INR specifically helps in managing warfarin therapy. Hemoglobin, on the other hand, is not typically monitored in relation to warfarin therapy.

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