Nursing Elites

1. A client is taking Spironolactone. Which of the following laboratory findings should the nurse monitor and report to the provider?

• A. Sodium level of 138 mEq/L
• B. Potassium level of 5.2 mEq/L
• C. Chloride level of 100 mEq/L
• D. Calcium level of 9.5 mg/dL

Correct answer: B

Rationale: The correct answer is B: Potassium level of 5.2 mEq/L. Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia (elevated potassium levels). A potassium level of 5.2 mEq/L is considered elevated and should be reported to the provider for further assessment and management to prevent potential complications. Choices A, C, and D are not directly affected by Spironolactone and do not typically require immediate reporting unless there are other underlying issues or specific instructions for those electrolytes.

2. A client has a new prescription for Digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching?

• A. Contact provider if heart rate is less than 60/min.
• B. Check pulse rate for 30 seconds and multiply the result by 2.
• C. Increase intake of sodium.
• D. Take with food if nausea occurs.

Correct answer: A

Rationale: The correct instruction for a client prescribed Digoxin for heart failure is to contact the provider if the heart rate is less than 60/min. Digoxin can affect heart rate, and a heart rate below 60/min may indicate toxicity, requiring prompt medical attention. Checking the pulse rate accurately and seeking medical advice are essential components of safe medication management. Choices B, C, and D are incorrect. Choice B is related to checking the pulse rate but does not address the critical action of contacting the provider if it is below 60/min. Increasing intake of sodium (Choice C) is inappropriate as high sodium levels can worsen heart failure. Taking Digoxin with food if nausea occurs (Choice D) does not address a critical aspect of Digoxin administration related to heart rate monitoring.

3. A client has a new prescription for a Nitroglycerin transdermal patch. Which of the following instructions should the nurse include?

• A. Apply the patch to the same site each day.
• B. Remove the patch at night.
• C. Cover the patch with a heating pad.
• D. Apply the patch to a hairless area of skin.

Correct answer: D

Rationale: The correct instruction is to apply the Nitroglycerin transdermal patch to a hairless area of skin. This ensures proper absorption of the medication. It is important to rotate the application site daily to prevent skin irritation and tolerance development. Applying the patch to the same site each day can lead to decreased efficacy and potential skin reactions. Removing the patch at night is not necessary as the patches are usually worn continuously to provide constant medication delivery. Covering the patch with a heating pad can increase the absorption of the medication and lead to an overdose, which is not recommended.

4. A patient is receiving spironolactone for heart failure. Which of the following findings should the nurse report to the provider?

• A. Hyperkalemia
• B. Hypernatremia
• C. Hyponatremia
• D. Hypokalemia

Correct answer: A

Rationale: The correct answer is A: Hyperkalemia. Spironolactone, a potassium-sparing diuretic, can lead to hyperkalemia due to its mechanism of action. Hyperkalemia, or elevated potassium levels, can result in serious cardiac complications and requires immediate medical attention. Therefore, the nurse should promptly report any signs or symptoms of hyperkalemia to prevent potential adverse outcomes in the patient. Choices B, C, and D are incorrect because spironolactone is not associated with hypernatremia, hyponatremia, or hypokalemia. Hyperkalemia is the critical finding that the nurse should report in a patient receiving spironolactone.

5. A client has been on levothyroxine therapy for several months. Which of the following findings indicates a therapeutic response to the medication?

• A. Decrease in level of thyroxine (T4)
• B. Increase in weight
• C. Increase in hours of sleep per night
• D. Decrease in level of thyroid stimulating hormone (TSH)

Correct answer: D

Rationale: A therapeutic response to levothyroxine is indicated by a decrease in the level of TSH. This decrease signifies that the body requires less stimulation to produce thyroid hormone, reflecting a normalization of thyroid function due to the medication's effectiveness. Choices A, B, and C are incorrect as an increase in T4 levels, weight gain, and increased sleep hours are not indicative of a therapeutic response to levothyroxine therapy.

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