Nursing Elites

1. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient’s electrolytes with careful attention to the levels of which electrolytes?

• A. Calcium and magnesium
• B. Sodium and calcium
• C. Potassium and chloride
• D. Potassium and magnesium

Correct answer: D

Rationale: Before administering digoxin, the nurse must review the patient's electrolyte levels, focusing on potassium and magnesium. Hypomagnesemia, similar to hypokalemia, can enhance the action of digitalis and lead to digitalis toxicity. Laxatives and diuretics, like hydrochlorothiazide, can deplete both potassium and magnesium. Therefore, monitoring these electrolytes is crucial to prevent potential adverse effects associated with digoxin therapy. Choice A (Calcium and magnesium) is incorrect because calcium levels are not specifically mentioned as crucial for digoxin therapy. Choice B (Sodium and calcium) is incorrect as sodium is not typically monitored in relation to digoxin therapy. Choice C (Potassium and chloride) is incorrect because although potassium is vital, chloride is not typically associated with digoxin therapy.

2. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?

• A. Administering a small test dose to determine if hypersensitivity exists
• B. Having epinephrine available in case of a severe hypersensitivity reaction
• C. Monitoring baseline vital signs, including temperature and blood pressure
• D. Obtaining a specimen for culture and sensitivity

Correct answer: D

Rationale: The most crucial action before administering an antibiotic for a urinary tract infection is to obtain a specimen for culture and sensitivity. This ensures the accurate identification of the causative organism and helps determine the most effective antibiotic therapy. Administering a test dose to detect hypersensitivity is usually reserved for cases with a strong suspicion of allergy to a needed antibiotic. Keeping epinephrine available is important when there is a significant risk of a severe allergic reaction. Monitoring baseline vital signs is essential during antibiotic therapy but is not the top priority before administering the first dose.

3. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action?

• A. Administer the medication as ordered.
• B. Encourage the patient to drink more fluids.
• C. Hold the medication and request an order for serum BUN and creatinine.
• D. Request an order for serum electrolytes and administer the medication.

Correct answer: C

Rationale: The correct action is to hold the medication and request an order for serum BUN and creatinine. Thiazide diuretics, such as hydrochlorothiazide, are contraindicated in renal failure. In this case, the patient has oliguria, which is a reduced urine output, indicating potential renal insufficiency. Before administering the diuretic, it is crucial to evaluate the patient's renal function through serum BUN and creatinine levels. Encouraging the patient to drink more fluids (Choice B) may not address the underlying issue of renal function. Administering the medication as ordered (Choice A) without assessing renal function can be harmful. Requesting serum electrolytes and administering the medication (Choice D) overlooks the need for a specific evaluation of renal function in this scenario.

4. Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to:

• A. Control chest pain.
• B. Reduce coronary artery vasospasm.
• C. Control the arrhythmias associated with MI.
• D. Revascularize the blocked coronary artery.

Correct answer: D

Rationale: Alteplase recombinant, or t-PA, is a thrombolytic enzyme used to dissolve clots and revascularize the blocked coronary artery in patients experiencing a myocardial infarction (MI). Administering t-PA within the first 6 hours of MI onset is crucial to restore blood flow to the affected area and minimize cardiac tissue damage. Therefore, the correct answer is to revascularize the blocked coronary artery. Choices A, B, and C are incorrect because while controlling chest pain, reducing coronary artery vasospasm, and managing arrhythmias are important goals in managing MI, the primary purpose of administering t-PA within the first 6 hours is to restore blood flow by dissolving clots and revascularizing the blocked coronary artery.

5. To help minimize the risk of postoperative respiratory complications after a hypophysectomy, during preoperative teaching, the nurse should instruct the client how to:

• A. Use incentive spirometry.
• B. Turn in bed.
• C. Take deep breaths.
• D. Cough.

Correct answer: C

Rationale: The correct answer is to instruct the client on how to take deep breaths. Deep breathing exercises are essential in preventing postoperative respiratory complications like atelectasis by promoting lung expansion. Using incentive spirometry is a more specific and advanced method of promoting deep breathing and lung expansion, making it a better choice than just turning in bed. While turning in bed may help with overall comfort and positioning, it is not as directly related to respiratory complications as deep breathing exercises. Coughing, although important for clearing secretions, is not as effective in preventing atelectasis as deep breathing exercises.

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