Nursing Elites

1. The LPN/LVN is assisting in caring for a client in the telemetry unit and is monitoring the client for cardiac changes indicative of hypokalemia. Which occurrence noted on the cardiac monitor indicates the presence of hypokalemia?

• A. Tall, peaked T waves
• B. ST-segment depression
• C. Prolonged P-R interval
• D. Widening of the QRS complex

Correct answer: B

Rationale: ST-segment depression can indicate hypokalemia, affecting the heart's electrical conduction. Hypokalemia leads to alterations in the repolarization phase of the cardiac action potential, resulting in ST-segment depression on the ECG. Tall, peaked T waves are indicative of hyperkalemia, not hypokalemia. A prolonged P-R interval is more commonly associated with first-degree heart block. Widening of the QRS complex is typically seen in conditions like bundle branch blocks or ventricular tachycardia, not specifically in hypokalemia.

2. A client is diagnosed with thrombophlebitis. The nurse should tell the client that which prescription is indicated?

• A. Bed rest, with bathroom privileges only
• B. Bed rest, keeping the affected extremity flat
• C. Bed rest, with elevation of the affected extremity
• D. Bed rest, with the affected extremity in a dependent position

Correct answer: C

Rationale: The correct answer is C: Bed rest, with elevation of the affected extremity. Elevating the affected extremity is crucial in managing thrombophlebitis as it helps reduce swelling and promotes venous return. By elevating the affected extremity, the gravitational force assists in venous blood flow back to the heart, thereby reducing the risk of complications associated with thrombophlebitis. Choices A, B, and D are incorrect because they do not address the need for elevation, which is specifically beneficial in the management of thrombophlebitis.

3. A client with hypertension is prescribed enalapril (Vasotec). The nurse should monitor the client for which adverse effect?

• A. Hypotension
• B. Hypertension
• C. Tachycardia
• D. Hyperglycemia

Correct answer: A

Rationale: Enalapril, an ACE inhibitor, can lead to hypotension, particularly following the initial dose or dosage escalation. This effect is due to the medication's mechanism of action in dilating blood vessels, which can result in lowered blood pressure. Monitoring for hypotension is crucial to prevent complications such as dizziness, lightheadedness, or fainting in clients taking enalapril. Choices B, C, and D are incorrect because enalapril does not typically cause hypertension, tachycardia, or hyperglycemia as adverse effects.

4. A client with a history of chronic heart failure is being discharged. Which instruction should the nurse include in the discharge teaching?

• A. Weigh yourself daily and report a weight gain of 2 pounds or more in a day.
• B. Restrict fluid intake to 2000 mL per day.
• C. Increase your salt intake to prevent electrolyte imbalance.
• D. Exercise vigorously at least three times a week.

Correct answer: A

Rationale: The correct answer is to weigh yourself daily and report a weight gain of 2 pounds or more in a day. This instruction is crucial because daily weights help in early detection of fluid retention, a common complication in heart failure. Monitoring weight is essential for managing heart failure and preventing exacerbations. Choice B is incorrect because fluid restriction may be necessary in some cases of heart failure, but a general limit of 2000 mL per day is not appropriate without individual assessment. Choice C is incorrect as increasing salt intake can worsen fluid retention and exacerbate heart failure symptoms. Choice D is incorrect because while exercise is beneficial for heart health, vigorous exercise may not be suitable for all heart failure patients and should be tailored to their specific condition.

5. A nurse is assessing a client who has been taking levothyroxine for hypothyroidism. Which of the following findings should the nurse report to the provider?

• A. Weight loss
• B. Insomnia
• C. Heat intolerance
• D. Dry skin

Correct answer: C

Rationale: The correct answer is C: Heat intolerance. Heat intolerance is a sign of levothyroxine toxicity and requires immediate attention. Weight loss may actually be an expected outcome of levothyroxine therapy as it can help regulate metabolism in hypothyroidism. Insomnia can occur as a side effect of levothyroxine but is not as concerning as heat intolerance. Dry skin is a common symptom of hypothyroidism and may improve with levothyroxine therapy, so it is not a priority finding to report to the provider.

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