Nursing Elites

1. A client with congestive heart failure is prescribed digoxin. What symptom indicates digoxin toxicity?

• A. Monitor for muscle weakness and fatigue.
• B. Monitor for increased appetite and weight gain.
• C. Monitor for nausea and vomiting.
• D. Monitor for blurred vision or seeing yellow halos around objects.

Correct answer: D

Rationale: Corrected Rationale: Blurred vision or seeing yellow halos around objects are signs of digoxin toxicity, which can be life-threatening. These symptoms indicate an overdose of digoxin, requiring immediate medical attention. Muscle weakness and fatigue (Choice A) are not typically associated with digoxin toxicity. Increased appetite and weight gain (Choice B) are not indicative of digoxin toxicity either. Nausea and vomiting (Choice C) are common side effects of digoxin but are not specific signs of toxicity. Therefore, the correct answer is to monitor for blurred vision or seeing yellow halos around objects.

2. A male client with heart failure becomes short of breath, anxious, and has pink frothy sputum. What is the first action the nurse should take?

• A. Consult the charge nurse about administering morphine.
• B. Administer the morphine sulfate as prescribed.
• C. Withhold the morphine until the dyspnea resolves.
• D. Review the need for the morphine prescription with the provider.

Correct answer: B

Rationale: The correct answer is B: Administer the morphine sulfate as prescribed. In this situation, the client is experiencing symptoms of acute pulmonary edema, a complication of heart failure. Morphine is indicated as it helps reduce anxiety and respiratory distress by decreasing preload and afterload. It dilates blood vessels, reducing the workload of the heart and improving oxygenation. The priority is to administer the morphine promptly to alleviate the client's distress and improve oxygenation. Consulting the charge nurse (A) or reviewing the need for the morphine prescription with the provider (D) would cause a delay in providing essential treatment. Withholding the morphine (C) would not be appropriate as it is indicated for this condition.

3. A male client with cirrhosis has jaundice and pruritus. He tells the nurse that he has been soaking in hot baths at night with no relief of his discomfort. Which action should the nurse take?

• A. Instruct the client to use a moisturizer immediately after the bath
• B. Advise the client to take shorter baths with less water
• C. Suggest taking antihistamines for the pruritus
• D. Encourage the client to use cooler water and apply calamine lotion after soaking

Correct answer: D

Rationale: In this situation, the client's pruritus (itching) is likely exacerbated by hot baths, which can worsen the itching sensation. Using cooler water will help soothe the skin and reduce pruritus. Additionally, applying calamine lotion after soaking can provide further relief. Instructing the client to use a moisturizer immediately after the bath (Choice A) may not address the root cause of pruritus aggravated by hot baths. Advising the client to take shorter baths with less water (Choice B) might not be as effective in relieving the itching sensation caused by cirrhosis. Suggesting antihistamines for the pruritus (Choice C) may not directly address the impact of hot baths on the client's discomfort.

4. Before administering digoxin to a client with heart failure, what is the most important assessment for the nurse to perform?

• A. Check the client's blood pressure
• B. Monitor the client's heart rate
• C. Assess the client's respiratory rate
• D. Review the client's potassium level

Correct answer: B

Rationale: The correct answer is to monitor the client's heart rate. Digoxin slows the heart rate, so it is crucial to assess the heart rate before administering the medication. If the heart rate is below 60 beats per minute, the dose should be held, and the healthcare provider should be notified. Checking the blood pressure (Choice A) is important but not as crucial as monitoring the heart rate in this case. Assessing the respiratory rate (Choice C) is not directly related to the action of digoxin. Reviewing the client's potassium level (Choice D) is important for clients taking digoxin due to the risk of hypokalemia, but assessing the heart rate takes priority.

5. A nurse is reviewing the medication list for a client with heart failure. Which medication should the nurse question?

• A. Furosemide
• B. Digoxin
• C. Ibuprofen
• D. Carvedilol

Correct answer: C

Rationale: The correct answer is C: Ibuprofen. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can cause fluid retention, which may worsen heart failure symptoms. It should be used with caution or avoided in clients with heart failure. Furosemide (choice A) is a diuretic commonly used in heart failure to reduce fluid overload. Digoxin (choice B) is a medication that helps the heart beat stronger and slower, often used in heart failure. Carvedilol (choice D) is a beta-blocker that is beneficial in heart failure management. Therefore, Ibuprofen is the medication that the nurse should question in this scenario.

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