Nursing Elites

1. The healthcare provider assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic?

• A. Tall, spiked T waves
• B. A prolonged QT interval
• C. A widening QRS complex
• D. Presence of a U wave

Correct answer: D

Rationale: The presence of a U wave is often associated with hypokalemia, a possible side effect of diuretic therapy like furosemide. Hypokalemia can lead to U wave formation on an electrocardiogram, making the presence of U waves a concerning finding in clients taking diuretics. Tall, spiked T waves are typically seen in hyperkalemia, not hypokalemia. A prolonged QT interval is more commonly associated with conditions like Long QT syndrome or certain medications, not specifically with diuretics. A widening QRS complex is usually seen in conditions affecting the conduction system of the heart, such as bundle branch blocks, rather than being directly related to diuretic use.

2. The nurse is caring for a client diagnosed with deep vein thrombosis (DVT). Which intervention should the nurse include in the client's plan of care to prevent the complication of pulmonary embolism?

• A. Encourage ambulation as tolerated.
• B. Administer anticoagulants as prescribed.
• C. Apply cold compresses to the affected area.
• D. Encourage the use of incentive spirometry.

Correct answer: B

Rationale: Administering anticoagulants as prescribed is crucial in preventing the complication of pulmonary embolism in clients with deep vein thrombosis. Anticoagulants help prevent the formation of new clots and the enlargement of existing ones, thereby reducing the risk of a pulmonary embolism. Encouraging ambulation as tolerated is beneficial for preventing complications related to immobility, but it is not the primary intervention to prevent pulmonary embolism in this case. Applying cold compresses to the affected area may help with pain and swelling but does not address the prevention of pulmonary embolism. Encouraging the use of incentive spirometry is more relevant in preventing respiratory complications such as atelectasis, not specifically pulmonary embolism.

3. A healthcare professional is reviewing laboratory results for a client with rheumatoid arthritis prescribed methotrexate. Which of the following laboratory results should the healthcare professional report to the provider?

• A. WBC count 1,200/mm³
• B. Hemoglobin 14 g/dL
• C. Platelets 150,000/mm³
• D. Blood glucose 110 mg/dL

Correct answer: A

Rationale: A WBC count of 1,200/mm³ indicates leukopenia, a serious side effect of methotrexate that can lead to increased risk of infections. It is crucial to report this finding promptly to the provider for further evaluation and possible adjustments in the treatment plan. Choices B, C, and D are within normal ranges and do not represent significant concerns related to methotrexate therapy in this context.

4. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds, expecting to hear which breath sounds bilaterally?

• A. Rhonchi
• B. Crackles
• C. Wheezes
• D. Diminished breath sounds

Correct answer: B

Rationale: In this scenario, the client is exhibiting signs of pulmonary edema, which can occur as a complication of myocardial infarction. Crackles are typically heard in cases of pulmonary edema, characterized by fluid accumulation in the lungs. These crackling sounds are heard during inspiration and sometimes expiration and are an indication of fluid-filled alveoli. Therefore, when assessing the client with these symptoms, the nurse would expect to hear crackles bilaterally. Rhonchi, which are coarse rattling respiratory sounds, are typically associated with conditions like bronchitis or pneumonia, not pulmonary edema. Wheezes are high-pitched musical sounds heard in conditions like asthma or COPD, not commonly present in pulmonary edema. Diminished breath sounds suggest decreased airflow or lung consolidation, not typical findings in pulmonary edema.

5. Before administering a calcium channel blocker to a client with hypertension, what parameter should the nurse check?

• A. Serum calcium level
• B. Apical pulse
• C. Blood pressure
• D. Respiratory rate

Correct answer: C

Rationale: Before administering a calcium channel blocker to a client with hypertension, the nurse should check the client's blood pressure. Calcium channel blockers are prescribed to lower blood pressure, so it is essential to assess the current blood pressure to ensure safe administration and monitor the medication's effectiveness. Checking the serum calcium level (Choice A) is not necessary before administering a calcium channel blocker, as it does not directly impact the drug's action. Monitoring the apical pulse (Choice B) is important for other types of medications like beta-blockers, not specifically for calcium channel blockers. Assessing the respiratory rate (Choice D) is not directly related to administering calcium channel blockers for hypertension.

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