Nursing Elites

1. The client with a diagnosis of heart failure is prescribed spironolactone (Aldactone). Which laboratory value should be monitored closely by the nurse?

• A. Serum calcium
• B. Serum potassium
• C. Serum sodium
• D. Serum glucose

Correct answer: B

Rationale: The correct answer is B: Serum potassium. Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia. Monitoring serum potassium levels is crucial to prevent adverse effects associated with high potassium levels, such as cardiac arrhythmias. Monitoring serum calcium (choice A) is not directly related to spironolactone use. Serum sodium (choice C) and serum glucose (choice D) are also not the primary laboratory values to monitor when a client is prescribed spironolactone for heart failure.

2. A client has a new prescription for propranolol. Which of the following instructions should be included?

• A. Take the medication with food.
• B. Monitor heart rate daily.
• C. Increase intake of potassium-rich foods.
• D. Avoid consuming dairy products.

Correct answer: B

Rationale: The correct answer is to monitor heart rate daily. Propranolol is a beta-blocker that can lower heart rate and blood pressure, so it is essential to monitor heart rate regularly to detect any signs of bradycardia, a potential side effect of the medication. Choice A is incorrect because propranolol can be taken with or without food. Choice C is incorrect as increasing potassium-rich foods is not specifically required with propranolol. Choice D is also incorrect as there is no need to avoid consuming dairy products with propranolol.

3. Which laboratory test should be monitored to evaluate the effectiveness of anticoagulant therapy in a client with deep vein thrombosis (DVT)?

• A. Complete blood count (CBC)
• B. Activated partial thromboplastin time (aPTT)
• C. Serum electrolytes
• D. Liver function tests

Correct answer: B

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory test monitored to evaluate the effectiveness of anticoagulant therapy, particularly with heparin. It measures the time it takes for blood to clot, and monitoring aPTT helps ensure the therapeutic range is maintained to prevent clot formation and excessive bleeding. Choices A, C, and D are incorrect because a complete blood count (CBC) assesses overall health, serum electrolytes evaluate the body's electrolyte balance, and liver function tests assess liver health, none of which directly evaluate the effectiveness of anticoagulant therapy for DVT.

4. The client is receiving furosemide (Lasix) for heart failure. What potential side effect should the nurse monitor for?

• A. Hypokalemia
• B. Hyperkalemia
• C. Hypernatremia
• D. Hypoglycemia

Correct answer: A

Rationale: The correct answer is A: Hypokalemia. Furosemide, a loop diuretic, causes potassium loss, leading to hypokalemia. Monitoring potassium levels is crucial because hypokalemia can result in cardiac arrhythmias and muscle weakness. Choices B, C, and D are incorrect because furosemide does not typically cause hyperkalemia, hypernatremia, or hypoglycemia.

5. The client will wear a Holter monitor for continuous cardiac monitoring over the next 24 hours. What action should the nurse take to assist the client?

• A. Shave the front of the client's chest
• B. Give the client a device holder to wear around the waist
• C. Teach the client to rest as much as possible during the next 24 hours
• D. Tell the client to cover the monitor in plastic wrap before taking a bath

Correct answer: B

Rationale: Providing the client with a device holder to wear around the waist allows them to comfortably carry the Holter monitor while engaging in normal activities throughout the 24-hour monitoring period. This approach supports the client's mobility and ensures the monitor is securely in place for accurate readings. Shaving the front of the client's chest is unnecessary and not a standard practice for Holter monitor placement. Instructing the client to rest as much as possible does not promote normal daily activities which are important for accurate monitoring. Covering the monitor in plastic wrap before bathing is not recommended as it may affect the functionality of the device.

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