Nursing Elites

1. The client is on spironolactone (Aldactone) and has a potassium level of 5.9 mEq/L. What is the nurse’s priority action?

• A. Hold the spironolactone and notify the healthcare provider.
• B. Administer potassium supplements.
• C. Continue the spironolactone as ordered.
• D. Increase the dose of spironolactone.

Correct answer: A

Rationale: The correct answer is A: Hold the spironolactone and notify the healthcare provider. A potassium level of 5.9 mEq/L is high, indicating hyperkalemia. Spironolactone is a potassium-sparing diuretic that can further increase potassium levels. Therefore, the priority action is to hold the medication to prevent exacerbating hyperkalemia and notify the healthcare provider for further guidance. Choice B is incorrect because administering potassium supplements would worsen hyperkalemia. Choice C is incorrect because continuing spironolactone could lead to a further increase in potassium levels. Choice D is incorrect because increasing the dose of spironolactone would exacerbate the hyperkalemia.

2. The client on amiodarone develops pulmonary fibrosis. What action should the nurse take?

• A. Notify the healthcare provider immediately.
• B. Continue the medication and monitor lung function.
• C. Discontinue the medication and start oxygen therapy.
• D. Reduce the dose and monitor respiratory status.

Correct answer: A

Rationale: When a client on amiodarone develops pulmonary fibrosis, a serious side effect, the immediate action the nurse should take is to notify the healthcare provider. This is crucial because pulmonary fibrosis can lead to severe respiratory compromise and requires prompt evaluation and management by the healthcare provider. Continuing the medication (choice B) can worsen the condition, and delaying action by reducing the dose and monitoring respiratory status (choice D) may not be appropriate given the seriousness of pulmonary fibrosis. Discontinuing the medication and starting oxygen therapy (choice C) may be necessary, but the priority is to notify the healthcare provider first for further assessment and guidance.

3. What is a condition where the blood flow to the brain is temporarily blocked, often referred to as a mini-stroke?

• A. Transient ischemic attack (TIA)
• B. Stroke
• C. Aneurysm
• D. Myocardial infarction

Correct answer: A

Rationale: A transient ischemic attack (TIA) is the correct answer. A TIA is often referred to as a mini-stroke because it is caused by a temporary blockage of blood flow to the brain. This blockage resolves on its own, typically within minutes to hours, leading to temporary symptoms similar to a stroke. Option B, 'Stroke,' is incorrect because a stroke involves a more prolonged interruption of blood flow to the brain. Option C, 'Aneurysm,' is incorrect as it is a bulge in a blood vessel that can rupture and cause bleeding, not a temporary blockage of blood flow. Option D, 'Myocardial infarction,' is also incorrect as it refers to a heart attack, not a condition involving the brain's blood flow.

4. The nurse is caring for a client on warfarin with an INR of 1.8. What is the most appropriate action?

• A. Increase the dose of warfarin.
• B. Administer vitamin K.
• C. Hold the warfarin and notify the healthcare provider.
• D. Monitor the client’s INR closely.

Correct answer: D

Rationale: An INR of 1.8 is below the therapeutic range for a client on warfarin, indicating the need for monitoring closely to ensure that the INR levels reach the desired therapeutic range. Increasing the dose of warfarin (Choice A) without proper monitoring may lead to an increased risk of bleeding. Administering vitamin K (Choice B) is not typically recommended unless the client is experiencing major bleeding or requires rapid reversal of warfarin's effects. Holding the warfarin and notifying the healthcare provider (Choice C) may be necessary in certain situations, but the immediate action in this case should be to monitor the client's INR closely to guide further management.

5. Which chronic respiratory condition is characterized by the narrowing and inflammation of the airways, leading to difficulty breathing?

• A. Asthma
• B. COPD
• C. Bronchitis
• D. Pneumonia

Correct answer: A

Rationale: Asthma is the correct answer. It is a chronic respiratory condition where the airways become inflamed and narrowed, leading to episodes of wheezing, breathlessness, chest tightness, and coughing. Asthma is characterized by reversible airflow obstruction, differentiating it from COPD, which involves irreversible airflow limitation. Bronchitis is an inflammation of the bronchial tubes without the same reversible airflow obstruction seen in asthma. Pneumonia is an infection of the lung tissue and does not involve chronic inflammation and narrowing of the airways like asthma.

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