Nursing Elites

1. The client is taking interferon alfa-2a (Roferon-A) and ribavirin (Virazole) combination therapy for hepatitis C and reports overwhelming feelings of depression. Which action should the nurse implement first?

• A. Recommend mental health counseling.
• B. Review the medication actions and interactions.
• C. Assess the client's daily activity level.
• D. Provide information about a support group.

Correct answer: B

Rationale: The priority action for the nurse is to review the medication actions and interactions. Interferon alfa-2a and ribavirin combination therapy for hepatitis C can lead to neuropsychiatric side effects, including depression. By assessing the medication actions and interactions, the nurse can identify if the depression is a known side effect of the medications, and further intervention or adjustment of the treatment plan may be required to address the client's emotional well-being. Recommending mental health counseling (choice A) may be necessary but should come after ensuring that the depression is not solely caused by medication side effects. Assessing the client's daily activity level (choice C) and providing information about a support group (choice D) are important interventions but addressing the medication's potential contribution to the depression takes precedence.

2. A client with a history of hypertension is being discharged on a low-sodium diet. Which statement by the client indicates a need for further teaching?

• A. I will use fresh herbs and spices instead of salt.
• B. I will avoid canned soups and processed foods.
• C. I can eat as much bacon and sausage as I want because they taste good.
• D. I will read food labels to check for sodium content.

Correct answer: C

Rationale: Choice C is the correct answer because bacon and sausage are high in sodium, which contradicts the low-sodium diet requirement. Consuming them freely would contribute to increased sodium intake, which is not suitable for managing hypertension. Choices A, B, and D demonstrate appropriate understanding and actions for a low-sodium diet, such as using alternatives to salt, avoiding processed foods, and checking food labels for sodium content.

3. The LPN/LVN is assisting in caring for a client in the telemetry unit who is receiving an intravenous infusion of 1000 mL of 5% dextrose with 40 mEq of potassium chloride. Which occurrence observed on the cardiac monitor indicates the presence of hyperkalemia?

• A. Tall, peaked T waves
• B. ST segment depressions
• C. Shortened P-R intervals
• D. Shortening of the QRS complex

Correct answer: A

Rationale: In hyperkalemia, tall, peaked T waves are a distinct ECG finding. These T waves can be seen as a result of increased serum potassium levels, affecting the repolarization phase of the cardiac action potential. It is crucial for healthcare providers to recognize this ECG change promptly as hyperkalemia can lead to serious cardiac arrhythmias and complications. ST segment depressions, shortened P-R intervals, and shortening of the QRS complex are not typically associated with hyperkalemia. ST segment depressions are more indicative of myocardial ischemia or infarction. Shortened P-R intervals may be seen in conditions like Wolff-Parkinson-White syndrome. Shortening of the QRS complex is associated with conditions affecting the conduction system of the heart, such as bundle branch blocks.

4. The nurse is informed during shift report that a client is experiencing occasional ventricular dysrhythmias. The nurse reviews the client's laboratory results, recalling that which electrolyte imbalance could be responsible for this development?

• A. Hypokalemia
• B. Hypernatremia
• C. Hypochloremia
• D. Hypercalcemia

Correct answer: A

Rationale: Hypokalemia, which is low potassium levels, can disrupt the normal electrical activity of the heart and lead to ventricular dysrhythmias. Potassium plays a crucial role in maintaining the heart's rhythm, and a deficiency can result in dangerous heart rhythm abnormalities. Hypernatremia (Choice B), which is high sodium levels, does not directly impact heart rhythm. Hypochloremia (Choice C), which is low chloride levels, is not typically associated with ventricular dysrhythmias. Hypercalcemia (Choice D), which is high calcium levels, is not a common cause of ventricular dysrhythmias.

5. A client has a new prescription for verapamil. Which of the following beverages should the client avoid while taking this medication?

• A. Orange juice
• B. Coffee
• C. Milk
• D. Grapefruit juice

Correct answer: D

Rationale: Grapefruit juice should be avoided while taking verapamil as it can increase drug levels and the risk of side effects. The interaction between grapefruit juice and verapamil can lead to higher concentrations of the medication in the bloodstream, potentially causing adverse effects. Orange juice, coffee, and milk do not have significant interactions with verapamil. Therefore, it is crucial for the client to avoid grapefruit juice to ensure the safe and effective use of verapamil.

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