Nursing Elites

1. A client on spironolactone (Aldactone) has a potassium level of 6.0 mEq/L. What is the nurse’s priority action?

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

Correct answer: A

Rationale: The correct action for a client on spironolactone with a potassium level of 6.0 mEq/L is to hold the medication and notify the healthcare provider. Spironolactone is a potassium-sparing diuretic that can further elevate potassium levels, which are already high. Administering a potassium supplement (Choice B) would exacerbate the hyperkalemia. Continuing the spironolactone as ordered (Choice C) could lead to worsening hyperkalemia. Increasing the dose of spironolactone (Choice D) would be contraindicated in the presence of elevated potassium levels.

2. The client is on digoxin and has severe digoxin toxicity. What is the nursing priority action?

• A. Check the potassium level.
• B. Give Digibind as an antidote.
• C. Change the dosing of digoxin to every other day.
• D. Administer a potassium supplement to decrease digoxin toxicity.

Correct answer: B

Rationale: The correct answer is to give Digibind as an antidote in cases of severe digoxin toxicity. Digibind works by binding to digoxin and preventing it from causing further harm. Checking the potassium level (choice A) is important but not the priority when the client has severe toxicity. Changing the dosing to every other day (choice C) is not appropriate in the setting of severe toxicity where immediate action is required. Giving a potassium supplement (choice D) may be needed eventually, but the priority is to administer Digibind to counteract the toxic effects of digoxin.

3. What procedure uses a balloon to open narrowed or blocked blood vessels in the heart?

• A. Angioplasty
• B. Coronary artery bypass graft
• C. Stent placement
• D. Valve replacement

Correct answer: A

Rationale: The correct answer is Angioplasty. Angioplasty is a procedure that involves using a balloon to open narrowed or blocked blood vessels in the heart, thereby improving blood flow. This choice is correct because it directly matches the description provided in the question. Choices B, C, and D are incorrect because they involve different procedures: Bypass graft is a surgical procedure to redirect blood flow, stent placement involves inserting a mesh tube to keep an artery open, and valve replacement is the surgical replacement of a heart valve.

4. The client on warfarin has an INR of 4.5. What is the most appropriate action by the nurse?

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

Correct answer: A

Rationale: An INR of 4.5 is elevated, indicating an increased risk of bleeding due to excessive anticoagulation. The most appropriate action for the nurse in this scenario is to administer vitamin K. Vitamin K helps reverse the anticoagulant effects of warfarin, thus lowering the INR and reducing the risk of bleeding. Holding the next dose of warfarin (choice B) is not sufficient to address the immediate high INR level. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the risk of bleeding. While monitoring the client's INR closely (choice D) is important, immediate action is required to address the critically high INR level, making the administration of vitamin K the priority intervention.

5. The healthcare provider is monitoring a client receiving lidocaine IV. What side effect is the healthcare provider most concerned about?

• A. Severe headache
• B. Nausea and vomiting
• C. Seizures
• D. Tremors

Correct answer: C

Rationale: Seizures are the most concerning side effect of lidocaine IV administration due to its potential to indicate lidocaine toxicity, which can lead to serious complications such as cardiovascular collapse. Headache, nausea, and tremors are not typically associated with lidocaine IV and are less concerning compared to seizures in this context.

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