Nursing Elites

1. A client with heart failure is receiving digoxin. Which finding should indicate to the nurse that the client is experiencing digoxin toxicity?

• A. Constipation
• B. Blurred vision
• C. Bradycardia
• D. Dry cough

Correct answer: C

Rationale: Bradycardia is a hallmark sign of digoxin toxicity. Digoxin, a medication used to treat heart conditions, can lead to toxicity manifesting as bradycardia. Bradycardia occurs due to the drug's effect on slowing down the heart rate excessively. Constipation (Choice A) is not typically associated with digoxin toxicity. Blurred vision (Choice B) is more commonly linked to visual disturbances caused by digoxin, but it is not a defining sign of toxicity. Dry cough (Choice D) is not a recognized symptom of digoxin toxicity. It is crucial for the nurse to recognize the early signs of digoxin toxicity to prevent serious complications and provide appropriate interventions promptly.

2. The client with a history of angina pectoris is being discharged after coronary artery bypass graft (CABG) surgery. Which statement by the client indicates a need for further teaching?

• A. I will avoid lifting heavy objects for at least 6 weeks.
• B. I will call the doctor if I develop a fever or drainage from my incisions.
• C. I will take my pain medication before doing any activities that might cause discomfort.
• D. I can resume my normal activities, including driving, as soon as I feel like it.

Correct answer: D

Rationale: The correct answer is D because after CABG surgery, patients need to follow specific guidelines for resuming activities, and driving is typically restricted for a certain period to ensure safety and proper recovery. Resuming normal activities too soon, including driving, can pose risks to the client's health and safety. It is essential to emphasize to the client the importance of following the healthcare provider's recommendations regarding activity restrictions post-surgery to prevent complications and promote optimal recovery. Choices A, B, and C are correct statements that align with post-CABG discharge instructions, emphasizing the importance of avoiding heavy lifting, monitoring for signs of infection, and managing pain effectively.

3. The LPN/LVN is assisting in caring for a client in the telemetry unit and is monitoring the client for cardiac changes indicative of hypokalemia. Which occurrence noted on the cardiac monitor indicates the presence of hypokalemia?

• A. Tall, peaked T waves
• B. ST-segment depression
• C. Prolonged P-R interval
• D. Widening of the QRS complex

Correct answer: B

Rationale: ST-segment depression can indicate hypokalemia, affecting the heart's electrical conduction. Hypokalemia leads to alterations in the repolarization phase of the cardiac action potential, resulting in ST-segment depression on the ECG. Tall, peaked T waves are indicative of hyperkalemia, not hypokalemia. A prolonged P-R interval is more commonly associated with first-degree heart block. Widening of the QRS complex is typically seen in conditions like bundle branch blocks or ventricular tachycardia, not specifically in hypokalemia.

4. A client has a new prescription for clozapine. Which of the following instructions should the nurse include?

• A. You should have your white blood cell count checked regularly.
• B. You should take this medication on an empty stomach.
• C. You should avoid eating foods high in tyramine.
• D. You should avoid taking this medication with milk.

Correct answer: A

Rationale: The correct answer is A: 'You should have your white blood cell count checked regularly.' Clozapine can lead to agranulocytosis, a serious condition characterized by a low white blood cell count. Regular monitoring of the white blood cell count is crucial to detect this adverse effect early and prevent serious complications. Choices B, C, and D are incorrect because taking clozapine on an empty stomach, avoiding foods high in tyramine, or avoiding taking the medication with milk are not specific instructions related to the potential adverse effect of agranulocytosis associated with clozapine.

5. A client has a new prescription for lisinopril. Which of the following findings should be reported to the provider by the nurse?

• A. Weight gain
• B. Dry cough
• C. Hypokalemia
• D. Increased appetite

Correct answer: B

Rationale: The correct answer is B - Dry cough. Lisinopril is known to cause a persistent dry cough as a common side effect. This adverse reaction can be bothersome to the client and may necessitate discontinuation of the medication. Weight gain, hypokalemia, and increased appetite are not typically associated with lisinopril and would not be as concerning as a dry cough when assessing for adverse effects.

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