Nursing Elites

1. A client with a new prescription for simvastatin is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should take this medication in the evening.'
• B. 'I should avoid drinking grapefruit juice.'
• C. 'I should expect my urine to be red-orange while taking this medication.'
• D. 'I will need to take this medication for the rest of my life.'

Correct answer: A

Rationale: The correct answer is A. Taking simvastatin in the evening is recommended because cholesterol synthesis increases at night. This timing maximizes the effectiveness of the medication in lowering cholesterol levels. Choice B is incorrect because grapefruit juice should be avoided with certain statins, but simvastatin is not significantly affected by grapefruit juice. Choice C is incorrect as red-orange urine is not an expected side effect of simvastatin. Choice D is incorrect because simvastatin is typically prescribed for managing cholesterol levels and may not need to be taken for the rest of the client's life.

2. In monitoring the effectiveness of warfarin therapy for a client with a history of atrial fibrillation, which laboratory value should the nurse monitor?

• A. Activated partial thromboplastin time (aPTT)
• B. Prothrombin time (PT) and international normalized ratio (INR)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are crucial laboratory values to monitor the effectiveness of warfarin therapy in clients with atrial fibrillation. These values help ensure that the client is within the therapeutic range and that the anticoagulant effect of warfarin is appropriate. Monitoring aPTT, platelet count, or ESR is not directly related to assessing the effectiveness of warfarin therapy in these cases.

3. Before administering digoxin (Lanoxin) to a client diagnosed with heart failure, the nurse should perform which assessment?

• A. Check the blood pressure.
• B. Obtain an electrocardiogram (ECG).
• C. Assess the apical pulse.
• D. Review the latest electrolyte levels.

Correct answer: C

Rationale: Assessing the apical pulse is crucial before administering digoxin because the medication can lead to bradycardia. Monitoring the apical pulse helps determine the heart rate, and digoxin is typically withheld if the pulse is below 60 beats per minute. This assessment is essential to prevent potential adverse effects associated with digoxin administration. Checking the blood pressure (Choice A) is important but not specific to digoxin administration. Obtaining an electrocardiogram (ECG) (Choice B) may provide valuable information but is not the primary assessment needed before administering digoxin. Reviewing the latest electrolyte levels (Choice D) is important for assessing the overall condition but is not the immediate assessment required before administering digoxin.

4. A client with a diagnosis of heart failure is receiving digoxin (Lanoxin) and furosemide (Lasix). The LPN/LVN should closely monitor the client for which potential complication?

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

Correct answer: B

Rationale: The correct answer is B: Hypokalemia. Furosemide is a loop diuretic that promotes the loss of potassium in the urine, potentially leading to hypokalemia. Hypokalemia increases the risk of digoxin toxicity, as digoxin's effects can be potentiated in the presence of low potassium levels. Monitoring for hypokalemia is crucial to prevent adverse effects and maintain the therapeutic effectiveness of digoxin in clients with heart failure. Choices A, C, and D are incorrect because furosemide does not typically cause hyperkalemia, hypernatremia, or hyponatremia. Instead, it commonly leads to hypokalemia due to increased potassium excretion.

5. A client with hypertension is prescribed enalapril (Vasotec). The nurse should monitor the client for which adverse effect?

• A. Hypotension
• B. Hypertension
• C. Tachycardia
• D. Hyperglycemia

Correct answer: A

Rationale: Enalapril, an ACE inhibitor, can lead to hypotension, particularly following the initial dose or dosage escalation. This effect is due to the medication's mechanism of action in dilating blood vessels, which can result in lowered blood pressure. Monitoring for hypotension is crucial to prevent complications such as dizziness, lightheadedness, or fainting in clients taking enalapril. Choices B, C, and D are incorrect because enalapril does not typically cause hypertension, tachycardia, or hyperglycemia as adverse effects.

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