Nursing Elites

1. The nurse is caring for a heart client on digoxin and notes a potassium level of 2.5. What is the appropriate priority nursing intervention?

• A. Do nothing as this is a normal potassium level.
• B. The potassium level is low so the nurse asks for an order for potassium.
• C. The nurse asks to check the digoxin level as low potassium can increase digoxin toxicity.
• D. The nurse stops the digoxin.

Correct answer: C

Rationale: The correct answer is C. When caring for a client on digoxin with a low potassium level, the priority nursing intervention is to check the digoxin level. Low potassium can increase the risk of digoxin toxicity. Checking the digoxin level will help determine if any adjustments to the medication regimen are needed to prevent potential harm. Choice A is incorrect as a potassium level of 2.5 is low, not normal. Choice B is not the priority as simply giving potassium may not address the underlying issue of potential digoxin toxicity. Choice D is not the initial action to take without assessing the digoxin level first.

2. What is the term for the amount of blood ejected by the left ventricle into the aorta per beat, determined by preload, contractility, and afterload?

• A. Stroke volume
• B. Cardiac output
• C. End-diastolic volume
• D. Ejection fraction

Correct answer: A

Rationale: The correct answer is A: Stroke volume. Stroke volume refers to the volume of blood ejected by the left ventricle during each heartbeat. This is determined by preload (the degree of stretch of the cardiac muscle fibers at the end of diastole), contractility (the force of myocardial contraction), and afterload (the pressure or resistance that the ventricle must overcome to eject blood). Choice B, Cardiac output, is the volume of blood pumped by the heart per minute and is calculated by multiplying the heart rate by the stroke volume. Choice C, End-diastolic volume, is the volume of blood in the ventricle at the end of diastole before contraction. Choice D, Ejection fraction, is the proportion of blood pumped out of the ventricle with each contraction, calculated by dividing the stroke volume by the end-diastolic volume.

3. This is the inflammation of the heart's inner lining, usually caused by an infection.

• A. Endocarditis
• B. Myocarditis
• C. Pericarditis
• D. Valvulitis

Correct answer: A

Rationale: Endocarditis is the inflammation of the inner lining of the heart's chambers and valves, usually caused by a bacterial infection. Myocarditis is the inflammation of the heart muscle, Pericarditis is the inflammation of the pericardium (the outer lining of the heart), and Valvulitis is the inflammation of the heart valves. Therefore, in this case, the correct answer is Endocarditis as it specifically refers to the inflammation of the heart's inner lining.

4. The nurse is administering a beta blocker to a client with a heart rate of 50 bpm. What is the priority action?

• A. Hold the beta blocker and notify the healthcare provider.
• B. Administer the beta blocker as ordered.
• C. Decrease the dose of the beta blocker.
• D. Monitor the client’s heart rate and reassess in 30 minutes.

Correct answer: A

Rationale: The correct action is to hold the beta blocker and notify the healthcare provider. A heart rate of 50 bpm is already low, and beta blockers can further decrease the heart rate, potentially causing adverse effects like bradycardia or heart block. Administering the beta blocker as ordered (Choice B) can exacerbate the low heart rate. Decreasing the dose of the beta blocker (Choice C) may not be sufficient to address the potential harm. Monitoring the client’s heart rate and reassessing in 30 minutes (Choice D) may delay necessary interventions if the heart rate drops further. Therefore, the priority is to hold the medication and seek guidance from the healthcare provider.

5. The client is on a beta blocker for hypertension. What should the nurse monitor for?

• A. Bradycardia
• B. Tachycardia
• C. Hypertension
• D. Respiratory distress

Correct answer: A

Rationale: Corrected Rationale: When a client is on a beta blocker for hypertension, the nurse should monitor for bradycardia. Beta blockers are known to decrease heart rate, which can lead to bradycardia. Tachycardia (choice B) is unlikely as beta blockers have the opposite effect. Hypertension (choice C) is the condition being treated, not a side effect of beta blockers. Respiratory distress (choice D) is not a common effect of beta blockers and is not typically monitored in clients taking beta blockers.

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