Nursing Elites

1. The nurse is caring for a client on amiodarone who develops a cough. What is the most appropriate action?

• A. Notify the healthcare provider immediately.
• B. Reassure the client that this is a common side effect.
• C. Continue the amiodarone and monitor the client’s symptoms.
• D. Discontinue the amiodarone immediately.

Correct answer: A

Rationale: The correct action when a client on amiodarone develops a cough, which can be a sign of pulmonary toxicity, a serious side effect of amiodarone, is to notify the healthcare provider immediately. This is crucial because pulmonary toxicity can lead to severe complications if not addressed promptly. Choices B and C are incorrect as they do not address the potential severity of the situation and may delay necessary intervention. Choice D of discontinuing amiodarone immediately without consulting the healthcare provider can be risky, as sudden discontinuation of the medication may have adverse effects on the client's condition.

2. Which chronic condition is characterized by abnormally thickened heart muscle, making it harder for the heart to pump blood efficiently?

• A. Hypertrophic cardiomyopathy
• B. Dilated cardiomyopathy
• C. Restrictive cardiomyopathy
• D. Ventricular hypertrophy

Correct answer: A

Rationale: Hypertrophic cardiomyopathy is the correct answer. In this condition, the heart muscle becomes abnormally thickened, leading to difficulties in pumping blood efficiently. Dilated cardiomyopathy (choice B) involves the enlargement of the heart chambers, not thickening of the heart muscle. Restrictive cardiomyopathy (choice C) is characterized by stiffening of the heart muscle, impairing its ability to fill properly. Ventricular hypertrophy (choice D) refers to the thickening of the heart's ventricle walls, which can result from various conditions, not solely hypertrophic cardiomyopathy.

3. The client on warfarin has an INR of 3.8. What is the most appropriate action by the nurse?

• A. Administer vitamin K.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Notify the healthcare provider immediately.

Correct answer: A

Rationale: An INR of 3.8 is elevated, indicating an increased risk of bleeding. Administering vitamin K can help reverse the effects of warfarin. Holding the next dose of warfarin would be appropriate if the INR was too high, but not as the first-line action. Increasing the dose of warfarin would worsen the situation by further increasing the INR. Notifying the healthcare provider is important, but immediate action to address the elevated INR is necessary.

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

• A. Hold the digoxin and notify the healthcare provider.
• B. Increase the dose of digoxin.
• C. Continue the current dose of digoxin.
• D. Administer potassium supplements.

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.

5. The client on spironolactone (Aldactone) has a potassium level of 5.6 mEq/L. What is the nurse’s priority action?

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

Correct answer: A

Rationale: The correct answer is A: Hold the spironolactone and notify the healthcare provider. A potassium level of 5.6 mEq/L is high, indicating hyperkalemia. Spironolactone is a potassium-sparing diuretic that can further elevate potassium levels. Therefore, the priority action is to withhold the medication to prevent exacerbating hyperkalemia and notify the healthcare provider for further management. Option B is incorrect because administering potassium supplements would worsen the hyperkalemia. Option C is incorrect as continuing spironolactone can lead to a further increase in potassium levels. Option D is incorrect as increasing the dose of spironolactone would be inappropriate in the presence of elevated potassium levels.

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