Nursing Elites

1. The nurse is administering a beta blocker to a client with a heart rate of 50 bpm. What is the priority action?

• A. Hold the beta blocker and notify the healthcare provider.
• B. Administer the beta blocker as ordered.
• C. Decrease the dose of the beta blocker.
• D. Monitor the client’s heart rate and reassess in 30 minutes.

Correct answer: A

Rationale: The correct action is to hold the beta blocker and notify the healthcare provider. A heart rate of 50 bpm is already low, and beta blockers can further decrease the heart rate, potentially causing adverse effects like bradycardia or heart block. Administering the beta blocker as ordered (Choice B) can exacerbate the low heart rate. Decreasing the dose of the beta blocker (Choice C) may not be sufficient to address the potential harm. Monitoring the client’s heart rate and reassessing in 30 minutes (Choice D) may delay necessary interventions if the heart rate drops further. Therefore, the priority is to hold the medication and seek guidance from the healthcare provider.

2. What test evaluates the heart's response to physical stress, often involving exercise on a treadmill while monitoring the heart?

• A. Stress test
• B. Echocardiogram
• C. Holter monitor
• D. CT angiography

Correct answer: A

Rationale: A stress test, also known as an exercise stress test, evaluates the heart's response to physical stress by monitoring its activity during exercise, typically on a treadmill. This test helps assess the heart's performance, detect coronary artery disease, and evaluate the effectiveness of heart treatments. Echocardiogram (choice B) is an ultrasound of the heart that provides detailed images of the heart's structure and function, but it does not involve physical stress like a stress test. Holter monitor (choice C) is a device for continuously monitoring the heart's rhythm and rate over a period (usually 24-48 hours), not during exercise. CT angiography (choice D) is a diagnostic test that uses X-rays to visualize blood vessels but does not involve physical stress like a stress test.

3. The client on spironolactone should avoid which of the following?

• A. Foods high in potassium
• B. Foods high in sodium
• C. Foods high in calcium
• D. Foods high in chloride

Correct answer: A

Rationale: The correct answer is A: Foods high in potassium. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium and excrete sodium. Consuming foods high in potassium while on spironolactone can lead to an excess of potassium in the body, potentially causing hyperkalemia. Choices B, C, and D are incorrect because spironolactone does not directly interact with sodium, calcium, or chloride in a way that would require specific dietary restrictions related to these minerals.

4. The client asks about side effects of taking digoxin. How does the nurse respond?

• A. Anorexia can be a side effect of digoxin.
• B. Tachycardia can be a side effect of digoxin.
• C. Constipation can be a side effect of digoxin.
• D. Urinary retention can be a side effect of digoxin.

Correct answer: A

Rationale: The correct answer is A: 'Anorexia can be a side effect of digoxin.' Anorexia, nausea, vomiting, and diarrhea are commonly known side effects of digoxin. Choice B, 'Tachycardia can be a side effect of digoxin,' is incorrect as digoxin is used to treat tachycardia, not cause it. Choice C, 'Constipation can be a side effect of digoxin,' is incorrect as constipation is not a typical side effect of digoxin. Choice D, 'Urinary retention can be a side effect of digoxin,' is also incorrect as urinary retention is not a common side effect associated with digoxin use.

5. The nurse is administering enoxaparin (Lovenox) to a client. What is the most important lab value to monitor?

• A. Platelet count
• B. Hemoglobin
• C. White blood cell count
• D. aPTT

Correct answer: A

Rationale: The correct answer is A: Platelet count. When administering enoxaparin, it is crucial to monitor the platelet count because enoxaparin can lead to a rare but serious side effect known as thrombocytopenia, which is a decrease in platelet levels. Monitoring the platelet count helps in detecting this adverse effect early. Choices B, C, and D are incorrect because hemoglobin, white blood cell count, and aPTT are not the most important lab values to monitor specifically for enoxaparin administration.

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