Nursing Elites

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

Correct answer: A

Rationale: The correct answer is A. It is crucial for clients on Digoxin to monitor their heart rate. A heart rate less than 60/min can indicate bradycardia, a potential side effect of Digoxin. Therefore, the client should be instructed to contact the provider if their heart rate is less than 60/min to prevent complications and receive appropriate management. Choices B, C, and D are incorrect. Checking the pulse rate for 30 seconds and multiplying by 2 is not specific to Digoxin administration. Increasing sodium intake is contraindicated as Digoxin can lead to sodium retention. Taking Digoxin with food if nausea occurs is not recommended as it may affect the drug's absorption.

2. A client is starting therapy with rituximab. Which of the following findings should the nurse instruct the client to report?

• A. Dizziness
• B. Fever
• C. Urinary frequency
• D. Dry mouth

Correct answer: B

Rationale: The nurse should instruct the client to report fever when starting rituximab therapy. Fever can be a sign of infection, which is a potential complication associated with rituximab. Early detection and treatment of infections are important to ensure the client's safety and well-being. Dizziness, urinary frequency, and dry mouth are not commonly associated with rituximab therapy and are less likely to be directly related to the medication's side effects. Therefore, fever is the most crucial symptom to report to healthcare providers.

3. A healthcare provider is educating a group of new parents about immunizations. The provider should instruct the parents that the series for which of the following vaccines is completed prior to the first birthday?

• A. Pneumococcal conjugate vaccine
• B. Meningococcal conjugate vaccine
• C. Varicella vaccine
• D. Rotavirus vaccine

Correct answer: D

Rationale: The correct answer is D, Rotavirus vaccine. The series for the Rotavirus vaccine is completed prior to the first birthday as it is only administered to infants less than 8 months of age. This vaccine provides protection against severe diarrhea and vomiting caused by rotavirus infection, which is common in infants and young children. Choices A, B, and C are incorrect because the series for these vaccines extends beyond the first birthday. Pneumococcal conjugate vaccine and Meningococcal conjugate vaccine are typically given in multiple doses up to 2 years of age, while the Varicella vaccine is usually administered between 12 to 15 months of age.

4. A client with HIV is beginning therapy with zidovudine. The nurse should monitor the client for which of the following adverse effects of this medication?

• A. Fatigue
• B. Blurred vision
• C. Ringing in the ears
• D. Constipation

Correct answer: A

Rationale: Fatigue is a common adverse effect of zidovudine due to its impact on bone marrow, leading to anemia. Zidovudine is known to suppress bone marrow function, resulting in decreased production of red blood cells and subsequently causing fatigue due to anemia. Monitoring for fatigue is essential to ensure early detection and management of this adverse effect.

5. During an admission assessment for a client with severe Aspirin toxicity, what finding should the nurse expect?

• A. Body temperature 35°C (95°F)
• B. Lung crackles
• C. Cool, dry skin
• D. Respiratory depression

Correct answer: D

Rationale: In severe Aspirin toxicity, respiratory depression can occur due to increasing respiratory acidosis. Aspirin toxicity leads to metabolic acidosis, stimulating the respiratory center in the brain to increase the respiratory rate initially. However, as the toxicity worsens, respiratory muscle fatigue and depression can occur, resulting in respiratory depression. This can lead to hypoxia, respiratory failure, and ultimately, respiratory arrest.

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