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 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. The client on warfarin has an INR of 5.5. What is the priority nursing action?

• A. Administer vitamin K as an antidote.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Administer fresh frozen plasma.

Correct answer: A

Rationale: An INR of 5.5 is significantly elevated, indicating an increased risk of bleeding. The priority nursing action in this situation is to administer vitamin K as an antidote to reverse the effects of warfarin and lower the INR. Holding the next dose of warfarin (choice B) is important but not as immediate as administering vitamin K. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the bleeding risk. Administering fresh frozen plasma (choice D) is not the first-line treatment for high INR due to warfarin.

4. This is a type of lung disease that results from the inhalation of certain dusts, often in the workplace, leading to lung damage.

• A. Pneumoconiosis
• B. Asbestosis
• C. Silicosis
• D. Anthracosis

Correct answer: A

Rationale: Pneumoconiosis is the correct answer. It is a lung disease caused by inhaling certain types of dust, commonly in a workplace setting, resulting in lung damage. Asbestosis (choice B) is a specific type of pneumoconiosis caused by asbestos fibers. Silicosis (choice C) is another type of pneumoconiosis caused by inhaling crystalline silica dust. Anthracosis (choice D) is a condition characterized by the accumulation of coal dust particles in the lungs, not necessarily resulting in lung damage.

5. The healthcare provider is administering IV nitroglycerin to a patient for chest pain. What is the most critical parameter to monitor?

• A. Heart rate
• B. Blood pressure
• C. Oxygen saturation
• D. Respiratory rate

Correct answer: B

Rationale: The correct answer is 'Blood pressure.' Nitroglycerin is a vasodilator that can cause a rapid drop in blood pressure, leading to hypotension. Monitoring the blood pressure is crucial to prevent potential complications such as hypotension-induced dizziness, syncope, or organ hypoperfusion. While heart rate, oxygen saturation, and respiratory rate are important parameters to monitor in a clinical setting, the immediate concern with IV nitroglycerin administration is the risk of hypotension, making blood pressure the most critical parameter to assess.

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