Nursing Elites

1. A healthcare provider is reviewing a client's medical history and notes that the client has a prescription for Digoxin. Which of the following findings is a manifestation of Digoxin toxicity?

• A. Elevated blood pressure
• B. Bradycardia
• C. Yellow-tinged vision
• D. Ringing in the ears

Correct answer: C

Rationale: Yellow-tinged vision, along with nausea, vomiting, and confusion, are common manifestations of Digoxin toxicity. Visual disturbances are important to recognize as they can indicate the need for immediate medical attention and potential adjustment of Digoxin therapy to prevent serious complications. Elevated blood pressure is not typically associated with Digoxin toxicity; instead, hypotension may occur. Bradycardia is a common therapeutic effect of Digoxin rather than a sign of toxicity. Ringing in the ears, or tinnitus, is also a potential side effect of Digoxin but is less specific to toxicity compared to yellow-tinged vision.

2. A patient on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness?

• A. Reduced cardiac function
• B. First-pass effect
• C. Reduced hepatic function
• D. Increased gastric motility

Correct answer: C

Rationale: In older adults, reduced hepatic function can lead to prolonged effects of medications metabolized by the liver. This prolonged effect may result in drowsiness the next morning. Adjusting the dosage of the hypnotic medication may be necessary for this client. Choices A, B, and D are incorrect. Reduced cardiac function (Choice A) is not typically associated with drowsiness due to medication effects. The first-pass effect (Choice B) relates to the initial metabolism of a drug in the liver before reaching systemic circulation, which is not directly linked to drowsiness the next morning. Increased gastric motility (Choice D) does not commonly cause drowsiness as described in the scenario.

3. When educating a client with a new prescription for albuterol, which instruction should the nurse include?

• A. Use the inhaler every 4 hours.
• B. Shake the inhaler before use.
• C. Take a deep breath before inhaling the medication.
• D. Use a spacer when using the inhaler.

Correct answer: B

Rationale: Shaking the albuterol inhaler before use is essential to ensure that the medication is evenly mixed and properly delivered when inhaled. This maximizes the effectiveness of the medication in opening the airways and relieving symptoms of bronchospasm.

4. Before administering lithium to a client with bipolar disorder who has been taking the medication for 1 year, the nurse should check to see that which of the following tests has been completed?

• A. Thyroid hormone assay
• B. Liver function tests
• C. Erythrocyte sedimentation rate
• D. Brain natriuretic peptide

Correct answer: A

Rationale: The correct answer is to check the thyroid hormone assay. Long-term lithium use can result in thyroid dysfunction, making it crucial to monitor the client's thyroid function regularly to detect any abnormalities early and prevent potential complications. Liver function tests (choice B) are not specifically associated with lithium therapy. Erythrocyte sedimentation rate (choice C) is a nonspecific test for inflammation and not directly related to lithium therapy. Brain natriuretic peptide (choice D) is a test used to diagnose heart failure and is not relevant to monitoring lithium therapy.

5. A client has a new prescription for Metformin. Which of the following adverse effects of Metformin should the nurse instruct the client to report to the provider?

• A. Somnolence
• B. Constipation
• C. Fluid retention
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A: Somnolence. Somnolence can indicate lactic acidosis, a rare but serious adverse effect of Metformin. Lactic acidosis is manifested by extreme drowsiness, hyperventilation, and muscle pain. Clients should be instructed to report these symptoms to their healthcare provider promptly to prevent further complications.

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