Nursing Elites

1. A nurse is providing teaching for a male client who has Schizophrenia and is taking Risperidone. Which of the following instructions should the nurse include in the teaching?

• A. Add extra snacks to your diet to prevent weight loss.
• B. Notify the provider if you develop breast enlargement.
• C. You may begin to have mild seizures while taking this medication.
• D. This medication is likely to increase your libido.

Correct answer: B

Rationale: The correct answer is B: 'Notify the provider if you develop breast enlargement.' Gynecomastia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider if these manifestations occur. Choices A, C, and D are incorrect. Adding extra snacks to the diet to prevent weight loss is not a specific instruction related to risperidone. Seizures are not a common side effect of risperidone, so the statement about mild seizures is inaccurate. Risperidone is more likely to cause sexual side effects like erectile dysfunction rather than increasing libido, making choice D incorrect.

2. 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.

3. A healthcare professional in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for Digoxin toxicity?

• A. Calcium 9.2 mg/dL
• B. Calcium 10.3 mg/dL
• C. Potassium 3.4 mEq/L
• D. Potassium 4.8 mEq/L

Correct answer: C

Rationale: The correct answer is C: Potassium 3.4 mEq/L. Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium levels can lead to fatal dysrhythmias, especially in older clients taking Digoxin, as potassium plays a crucial role in the heart's electrical activity. Choices A and B are related to calcium levels, which do not directly increase the risk of Digoxin toxicity. Choice D, Potassium 4.8 mEq/L, is within the expected reference range and would not increase the risk of Digoxin toxicity.

4. A client with angina is being taught how to use nitroglycerin transdermal ointment. Which instruction should the nurse include?

• A. Remove the prior dose before applying a new dose.
• B. Rub the ointment directly into the skin until it is no longer visible.
• C. Cover the applied ointment with a clean gauze pad.
• D. Apply the ointment to the same skin area each time.

Correct answer: A

Rationale: The correct instruction is to remove the prior dose before applying a new one to prevent toxicity. Nitroglycerin ointment can cause adverse effects if accumulated doses are not removed. Rubbing the ointment until it's not visible or covering it with gauze may alter absorption. Applying it to the same area each time can lead to skin irritation or desensitization.

5. A client has a new prescription for Labetalol. Which of the following instructions should be included?

• A. Take this medication at bedtime.
• B. Avoid sudden discontinuation of the medication.
• C. Increase your intake of sodium-rich foods.
• D. Avoid drinking grapefruit juice.

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid sudden discontinuation of Labetalol. Abrupt discontinuation of beta-blockers like Labetalol can lead to rebound hypertension and other cardiac issues. It is important for clients to taper off the medication under healthcare provider guidance to prevent potential complications.

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