Nursing Elites

1. A client has a new prescription for metoprolol. Which of the following instructions should the nurse include?

• A. Monitor your blood pressure daily.
• B. Take the medication with food.
• C. Increase your intake of potassium-rich foods.
• D. Avoid consuming grapefruit juice.

Correct answer: A

Rationale: The correct answer is A, 'Monitor your blood pressure daily.' When a client is prescribed metoprolol, it is important to monitor blood pressure daily because the medication can cause hypotension, leading to low blood pressure. Regular monitoring allows for the early detection of any potential issues and adjustment of treatment if necessary. Choices B, C, and D are incorrect. Taking metoprolol with food is not necessary, increasing potassium-rich foods is not directly related to metoprolol therapy, and avoiding grapefruit juice is more relevant for certain other medications that interact with grapefruit.

2. A client with atrial fibrillation is receiving warfarin (Coumadin). The nurse should monitor which laboratory test to determine the effectiveness of the therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Complete blood count (CBC)
• D. Fibrinogen level

Correct answer: A

Rationale: To monitor the effectiveness of warfarin therapy in a client with atrial fibrillation, the nurse should assess the Prothrombin time (PT) and international normalized ratio (INR) levels. These tests help determine the clotting ability of the blood and ensure that the client's anticoagulation levels are within the therapeutic range, reducing the risk of bleeding or clotting complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy. Complete blood count (CBC) (Choice C) provides information about the cellular components of blood but does not directly assess the effectiveness of warfarin therapy. Fibrinogen level (Choice D) is not typically used to monitor warfarin therapy; it reflects the level of fibrinogen in the blood, which is involved in the clotting process.

3. A client with heart failure is receiving digoxin. Which finding should indicate to the nurse that the client is experiencing digoxin toxicity?

• A. Constipation
• B. Blurred vision
• C. Bradycardia
• D. Dry cough

Correct answer: C

Rationale: Bradycardia is a hallmark sign of digoxin toxicity. Digoxin, a medication used to treat heart conditions, can lead to toxicity manifesting as bradycardia. Bradycardia occurs due to the drug's effect on slowing down the heart rate excessively. Constipation (Choice A) is not typically associated with digoxin toxicity. Blurred vision (Choice B) is more commonly linked to visual disturbances caused by digoxin, but it is not a defining sign of toxicity. Dry cough (Choice D) is not a recognized symptom of digoxin toxicity. It is crucial for the nurse to recognize the early signs of digoxin toxicity to prevent serious complications and provide appropriate interventions promptly.

4. A client with a diagnosis of heart failure is being discharged. What information should the nurse emphasize to the client regarding the use of a daily weight log?

• A. Report any weight gain of more than 2 pounds in a day
• B. Weigh yourself after eating breakfast each morning
• C. Use the same scale each day to check your weight
• D. Record your weight daily and report any changes

Correct answer: A

Rationale: The correct answer is A: 'Report any weight gain of more than 2 pounds in a day.' Sudden weight gain of more than 2 pounds in a day may indicate fluid retention and worsening heart failure. This information is crucial for early intervention and monitoring of the client's condition. Weighing after eating breakfast (choice B) may not provide consistent results due to varying food and fluid intake. Using the same scale each day (choice C) ensures accuracy and consistency in weight measurements. Recording weight daily (choice D) is more frequent than necessary and may not be practical for all clients. It is essential to focus on significant weight changes to prevent unnecessary alarm or confusion.

5. The client is being ambulated due to activity intolerance caused by bacterial endocarditis. How can the nurse determine that the client is best tolerating ambulation?

• A. Mild dyspnea after walking 10 feet
• B. Minimal chest pain rated 1 on a 1-to-10 pain scale
• C. Pulse rate that increases from 68 to 94 beats per minute
• D. Blood pressure that increases from 114/82 to 118/86 mm Hg

Correct answer: D

Rationale: A slight increase in blood pressure without significant symptoms indicates that the client is tolerating the activity. In this scenario, a mild increase in blood pressure without other symptoms is a positive sign of tolerance to ambulation despite the underlying condition of bacterial endocarditis. Choices A, B, and C are not the best indicators of tolerance to ambulation in this case. Mild dyspnea after walking a short distance, minimal chest pain, and an increase in pulse rate are common signs that the activity might not be well-tolerated by the client with a history of bacterial endocarditis.

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