the client is receiving digoxin and has a potassium level of 28 meql what is the nurses priority action
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Nursing Elites

ATI RN

Cardiovascular System Exam

1. The client is receiving digoxin and has a potassium level of 2.8 mEq/L. What is the nurse’s priority action?

Correct answer: A

Rationale: The correct answer is to hold the digoxin and notify the healthcare provider. A potassium level of 2.8 mEq/L indicates hypokalemia, which can increase the risk of digoxin toxicity. Holding the medication and informing the healthcare provider is crucial to prevent adverse effects. Choice B is incorrect because increasing the dose of digoxin would further raise the risk of toxicity. Choice C is incorrect as continuing the current dose could exacerbate the toxicity risk. Choice D is incorrect because administering potassium supplements alone is not sufficient to address the potential digoxin toxicity; the first step should be to hold the digoxin and seek further guidance.

2. The client is on a beta blocker for hypertension. What should the nurse monitor for?

Correct answer: A

Rationale: Corrected Rationale: When a client is on a beta blocker for hypertension, the nurse should monitor for bradycardia. Beta blockers are known to decrease heart rate, which can lead to bradycardia. Tachycardia (choice B) is unlikely as beta blockers have the opposite effect. Hypertension (choice C) is the condition being treated, not a side effect of beta blockers. Respiratory distress (choice D) is not a common effect of beta blockers and is not typically monitored in clients taking beta blockers.

3. What is a chronic condition where the heart muscle becomes weakened and enlarged, reducing its ability to pump blood effectively?

Correct answer: A

Rationale: Dilated cardiomyopathy is characterized by the weakening and enlargement of the heart muscle, leading to its reduced ability to pump blood effectively. This condition is different from hypertrophic cardiomyopathy, which involves abnormal thickening of the heart muscle, myocarditis, which is inflammation of the heart muscle, and pericarditis, which is inflammation of the pericardium. Therefore, the correct answer is Dilated cardiomyopathy.

4. What is a blood clot that forms in a vein, often in the legs, and can cause serious complications if it travels to the lungs?

Correct answer: A

Rationale: The correct answer is Deep vein thrombosis (DVT). DVT is a blood clot that forms in a deep vein, typically in the legs, and can lead to serious complications if it breaks loose and travels to the lungs, causing a pulmonary embolism. Varicose veins (choice C) are enlarged, twisted veins usually found in the legs but are not related to blood clots. Atherosclerosis (choice D) is a condition where arteries become narrowed and hardened due to a buildup of plaque, not directly related to blood clots.

5. What is a condition where the lung's alveoli are permanently enlarged and damaged, leading to shortness of breath?

Correct answer: A

Rationale: Emphysema is the correct answer. It is a chronic lung condition characterized by the permanent enlargement and damage of the alveoli, leading to shortness of breath and impaired oxygen exchange. Bronchitis is the inflammation of the bronchial tubes, not specifically related to alveolar damage. Atelectasis is the collapse of lung tissue, not enlargement. Pulmonary fibrosis involves scarring and thickening of lung tissue, different from the alveolar damage seen in emphysema.

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