Nursing Elites

1. Which order should the nurse question?

• A. The addition of a loop diuretic with digoxin.
• B. The addition of a beta blocker with digoxin.
• C. A digoxin dose of 0.125 mg per day.
• D. The addition of an ACE inhibitor with digoxin.

Correct answer: B

Rationale: The correct answer is B because adding a beta blocker to digoxin can potentiate the bradycardic effect of digoxin, leading to serious complications such as heart block. This combination requires caution as it can significantly slow down the heart rate. Choices A, C, and D are not the best options to question in this scenario. Loop diuretics are commonly used with digoxin, a digoxin dose of 0.125 mg per day is within the typical range, and ACE inhibitors are often prescribed alongside digoxin for managing heart conditions.

2. What condition is characterized by the inflammation of the pleura, causing sharp chest pain that worsens with breathing?

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

Correct answer: A

Rationale: The correct answer is Pleurisy. Pleurisy is the inflammation of the pleura, the lining surrounding the lungs, which causes sharp chest pain that worsens with breathing. Pericarditis (choice B) is the inflammation of the pericardium, the sac around the heart, which typically causes chest pain that worsens when lying down. Endocarditis (choice C) is the inflammation of the inner lining of the heart chambers and valves, leading to symptoms like fever, fatigue, and abnormal heart sounds. Myocarditis (choice D) is inflammation of the heart muscle, which can cause symptoms such as chest pain, fatigue, and shortness of breath.

3. The client on nitroglycerin complains of a headache. What is the most appropriate response by the nurse?

• A. Administer acetaminophen as prescribed for the headache.
• B. Hold the next dose of nitroglycerin.
• C. Discontinue the nitroglycerin immediately.
• D. Notify the healthcare provider immediately.

Correct answer: A

Rationale: The correct response is to administer acetaminophen as prescribed for the headache. Headaches are a common side effect of nitroglycerin due to vasodilation. Administering acetaminophen can help relieve the headache. Holding the next dose of nitroglycerin (Choice B) may not address the current headache, and discontinuing nitroglycerin immediately (Choice C) without healthcare provider guidance can be dangerous due to the potential for rebound hypertension. Notifying the healthcare provider immediately (Choice D) is not necessary for a common side effect like a headache, and the nurse can manage this symptom independently.

4. The nurse is administering digoxin to a client with a heart rate of 45 bpm. What is the nurse’s priority action?

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

Correct answer: A

Rationale: The correct answer is to hold the digoxin and notify the healthcare provider. A heart rate of 45 bpm is already low, and digoxin can further decrease the heart rate, leading to serious complications like bradycardia or heart block. Administering the medication can exacerbate the bradycardia, hence it should be withheld. Increasing the dose of digoxin is contraindicated due to the client's low heart rate. Monitoring the heart rate alone without taking immediate action to withhold the medication is not the priority when faced with the risk of further lowering the heart rate.

5. The nurse is caring for a client on enalapril (Vasotec). What is the most important side effect to monitor?

• A. Cough
• B. Hyperkalemia
• C. Hypotension
• D. Dizziness

Correct answer: A

Rationale: The correct answer is A: Cough. Enalapril is an ACE inhibitor, and cough is a common side effect associated with this class of medication. Monitoring for cough is crucial as it can indicate the development of a potentially serious condition known as angioedema. Hyperkalemia (choice B) is a possible side effect of ACE inhibitors but is not the most important side effect to monitor. Hypotension (choice C) and dizziness (choice D) are also potential side effects of enalapril; however, cough takes precedence due to its association with angioedema, a severe adverse reaction.

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