Nursing Elites

1. A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention for signs of digoxin toxicity?

• A. Apical heart rate of 60 beats/min
• B. Sweating across the forehead
• C. Poor sucking effort
• D. Respiratory rate of 30 breaths/min

Correct answer: A

Rationale: A heart rate of 60 beats/min for a 6-month-old infant warrants immediate intervention as it falls below the normal range. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered within normal limits. Bradycardia (heart rate <60 beats/min) in infants can be a sign of digoxin toxicity, necessitating prompt evaluation and intervention to prevent adverse effects. Sweating across the forehead (Choice B) is a non-specific symptom and may not directly indicate digoxin toxicity. Poor sucking effort (Choice C) and a respiratory rate of 30 breaths/min (Choice D) are not typically associated with digoxin toxicity and do not require immediate intervention in the context of this question.

2. Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better. Which explanation should the PN provide?

• A. It takes 1 to 4 weeks for antidepressant medications to become effective.
• B. The dosage may need to be increased; I will contact your health care provider.
• C. Depression is difficult to treat with drugs alone. Therapy sessions would enhance their effectiveness.
• D. Based on your child's response to this drug, the health care provider is reviewing your medication regimen.

Correct answer: A

Rationale: Antidepressant medications typically require 1 to 4 weeks to reach their full therapeutic effect. It is crucial to educate the family that during the initial week of treatment, the child may experience heightened anxiety. Therefore, it is important to wait for the medication to take its full course before assessing its effectiveness.

3. A client with a diagnosis of bipolar disorder is prescribed oxcarbazepine. The nurse should monitor for which potential adverse effect?

• A. Hyponatremia
• B. Agranulocytosis
• C. Liver toxicity
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A, Hyponatremia. Oxcarbazepine, an anticonvulsant used in bipolar disorder, can lead to hyponatremia. This is because it can cause the body to retain water, leading to a dilution of sodium levels in the blood. Monitoring sodium levels is crucial to prevent complications such as confusion, seizures, and even coma. Choices B, C, and D are incorrect. Agranulocytosis is not typically associated with oxcarbazepine use. Liver toxicity is a potential adverse effect of some medications but not commonly seen with oxcarbazepine. While weight gain can be a side effect of certain medications used in bipolar disorder treatment, it is not a common adverse effect of oxcarbazepine.

4. A client with a diagnosis of bipolar disorder is prescribed valproate. The nurse should monitor for which potential adverse effect?

• A. Weight gain
• B. Hair loss
• C. Hyperglycemia
• D. Hypoglycemia

Correct answer: A

Rationale: The correct answer is A: Weight gain. Valproate is known to cause weight gain as a common adverse effect. It is important for the nurse to monitor the client's weight regularly while on this medication to detect and address any changes that may occur.

5. A client with diabetes mellitus type 2 is prescribed canagliflozin. The nurse should include which instruction in the client's teaching plan?

• A. Report any signs of urinary tract infection.
• B. Take this medication with meals.
• C. Avoid alcohol while taking this medication.
• D. Avoid taking this medication with grapefruit juice.

Correct answer: A

Rationale: The correct instruction to include in the client's teaching plan is to report any signs of urinary tract infection. Canagliflozin, a medication used in diabetes mellitus type 2, can increase the risk of urinary tract infections. Instructing the client to report any signs of infection is crucial for early intervention and management. Choices B, C, and D are incorrect because there is no specific requirement to take canagliflozin with meals, avoid alcohol, or restrict grapefruit juice consumption while on this medication.

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