Nursing Elites

1. The client on spironolactone (Aldactone) has a potassium level of 5.8 mEq/L. What is the nurse’s priority action?

• A. Hold the spironolactone and notify the healthcare provider.
• B. Administer a potassium supplement.
• C. Continue the spironolactone as ordered.
• D. Increase the dose of spironolactone.

Correct answer: A

Rationale: With a potassium level of 5.8 mEq/L, which is high, the priority action for the nurse is to hold the spironolactone. Spironolactone is a potassium-sparing diuretic that can further increase potassium levels. Therefore, it is crucial to prevent exacerbating hyperkalemia by discontinuing the medication. Notifying the healthcare provider is necessary for further guidance and potential adjustments to the treatment plan. Administering a potassium supplement (Choice B) would be contraindicated since the client already has elevated potassium levels. Continuing the spironolactone as ordered (Choice C) can worsen hyperkalemia. Increasing the dose of spironolactone (Choice D) would be unsafe and exacerbate the high potassium levels.

2. Which of the following is a rare but serious condition where the pulmonary arteries become narrowed, increasing the blood pressure in the lungs?

• A. Pulmonary hypertension
• B. Pulmonary embolism
• C. Pulmonary fibrosis
• D. Aortic stenosis

Correct answer: A

Rationale: The correct answer is A, Pulmonary hypertension. Pulmonary hypertension is a rare but serious condition characterized by high blood pressure in the arteries of the lungs, which can lead to heart failure. Pulmonary embolism (choice B) involves a blockage in one of the pulmonary arteries in the lungs. Pulmonary fibrosis (choice C) is a lung disease that causes lung tissue scarring. Aortic stenosis (choice D) is a condition where the aortic valve narrows, affecting blood flow from the heart.

3. Which condition involves the body's immune system attacking the lungs and kidneys, causing severe respiratory and renal damage?

• A. Goodpasture syndrome
• B. Sarcoidosis
• C. Wegener's granulomatosis
• D. Interstitial lung disease

Correct answer: A

Rationale: Goodpasture syndrome is the correct answer. It is an autoimmune disease characterized by the immune system attacking the lungs and kidneys, leading to bleeding in the lungs and kidney failure. Sarcoidosis primarily affects the lungs and lymph nodes, not the kidneys. Wegener's granulomatosis affects the lungs, sinuses, and kidneys, but it is characterized by inflammation of blood vessels. Interstitial lung disease involves scarring of the lung tissue, not direct immune system attacks on the lungs and kidneys.

4. What are the pressure-sensitive structures located in the aortic and carotid bodies called?

• A. Baroreceptors
• B. Chemoreceptors
• C. Nociceptors
• D. Mechanoreceptors

Correct answer: A

Rationale: Baroreceptors are the correct answer. Baroreceptors are specialized sensory receptors that detect changes in pressure within blood vessels. They are primarily located in the aortic arch and carotid sinuses, where they play a crucial role in regulating blood pressure. Chemoreceptors (Choice B) are receptors that detect chemical changes, not pressure changes. Nociceptors (Choice C) are responsible for detecting painful stimuli. Mechanoreceptors (Choice D) respond to mechanical stimuli such as touch, pressure, and vibration, but they are not specifically located in the aortic and carotid bodies.

5. What test measures the electrical activity of the heart over a 24- or 48-hour period?

• A. Holter monitor
• B. Electrocardiogram
• C. Stress test
• D. Chest X-ray

Correct answer: A

Rationale: The correct answer is A, Holter monitor. A Holter monitor is a portable device that continuously records the heart's electrical activity over 24 to 48 hours, aiding in the diagnosis of arrhythmias and other heart conditions. Choice B, an Electrocardiogram, provides a snapshot of the heart's electrical activity at a specific point in time, not over an extended period like a Holter monitor. Choice C, a Stress test, measures how the heart responds to physical activity and is not used for continuous monitoring of electrical activity. Choice D, a Chest X-ray, is used to visualize the structures of the chest, not to measure the heart's electrical activity.

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