Nursing Elites

1. A client with a history of coronary artery disease (CAD) is prescribed simvastatin (Zocor). The nurse should teach the client about which potential side effect?

• A. Muscle pain
• B. Dry mouth
• C. Drowsiness
• D. Diarrhea

Correct answer: A

Rationale: Muscle pain is a common side effect of statins like simvastatin and can indicate a serious condition called rhabdomyolysis. Rhabdomyolysis is a severe condition where muscle fibers break down rapidly, releasing myoglobin into the bloodstream, which can lead to kidney damage. Therefore, it's important for the nurse to educate the client about this potential side effect and to promptly report any muscle pain to the healthcare provider. Dry mouth, drowsiness, and diarrhea are not commonly associated with simvastatin use and are less concerning compared to the risk of rhabdomyolysis.

2. The LPN/LVN is assisting in the care of a client with a diagnosis of heart failure who is receiving digoxin (Lanoxin). Which laboratory result should the nurse monitor closely?

• A. Serum sodium
• B. Serum potassium
• C. Serum calcium
• D. Serum glucose

Correct answer: B

Rationale: The correct answer is serum potassium. Monitoring serum potassium levels is crucial when a client is receiving digoxin (Lanoxin) because low potassium levels can increase the risk of digoxin toxicity. Digoxin and low potassium levels can lead to serious cardiac complications, such as arrhythmias. Therefore, close monitoring of serum potassium is essential to prevent adverse effects and ensure the safe administration of digoxin in clients with heart failure. Serum sodium, serum calcium, and serum glucose levels are also important laboratory values to monitor in clients with heart failure, but they are not directly associated with the risk of digoxin toxicity. Monitoring these values helps in assessing overall health status, fluid balance, and metabolic functions in the client.

3. A client diagnosed with coronary artery disease (CAD) reports chest pain radiating to the left arm. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. What is the next appropriate nursing action?

• A. Administer another dose of nitroglycerin.
• B. Notify the healthcare provider immediately.
• C. Have the client lie down and stay calm.
• D. Give the client aspirin 325 mg to chew.

Correct answer: A

Rationale: If chest pain persists after the first dose of nitroglycerin, it is appropriate to administer a second dose while continuing to monitor the client's response. Nitroglycerin helps dilate blood vessels and improve blood flow to the heart, relieving chest pain associated with coronary artery disease. Reassessing the client's response to a second dose is crucial before considering other interventions like contacting the healthcare provider or providing additional medications. Administering another dose of nitroglycerin aligns with the standard protocol for managing ongoing chest pain in clients with CAD.

4. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed?

• A. Strict bed rest for 24 hours
• B. Bathroom privileges and self-care activities
• C. Unrestricted activities because the client is monitored
• D. Unsupervised hallway ambulation with distances less than 200 feet

Correct answer: B

Rationale: After being transferred from the CCU to the general medical unit with cardiac monitoring, the client with MI is typically prescribed bathroom privileges and self-care activities. This approach allows for gradual recovery and mobility while still being closely monitored, promoting the client's overall well-being and independence. Choice A, strict bed rest for 24 hours, is too restrictive and not recommended for MI patients as it can lead to complications like deep vein thrombosis. Choice C, unrestricted activities, is also not appropriate as MI patients usually require monitoring and gradual re-introduction to activities. Choice D, unsupervised hallway ambulation with distances less than 200 feet, may be too strenuous for a client who just got transferred from the CCU and needs a more gradual approach to activity.

5. When providing teaching to a client with a new prescription for atorvastatin, which of the following instructions should the nurse include?

• A. Take the medication in the evening.
• B. Take the medication with food.
• C. Increase your intake of grapefruit juice.
• D. Avoid consuming dairy products.

Correct answer: A

Rationale: The correct instruction for a client with a new prescription for atorvastatin is to take the medication in the evening. Atorvastatin is more effective when taken at night because cholesterol synthesis is higher during this time. This timing helps optimize the drug's cholesterol-lowering effects and enhances its overall efficacy in managing lipid levels. Choices B, C, and D are incorrect. Taking atorvastatin with food can decrease its absorption, grapefruit juice can interact with atorvastatin leading to increased side effects, and there is no specific need to avoid dairy products while on atorvastatin unless instructed otherwise by the healthcare provider.

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