Nursing Elites

1. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take?

• A. Administer the medications and request an order for serum electrolytes.
• B. Give both medications and evaluate serum blood glucose frequently.
• C. Hold the digoxin and notify the provider.
• D. Hold the hydrochlorothiazide and notify the provider.

Correct answer: C

Rationale: In this scenario, the patient is experiencing symptoms of digoxin toxicity, such as blurred vision and bradycardia. When thiazide diuretics like hydrochlorothiazide are taken with digoxin, the patient is at risk of digoxin toxicity due to the potential for thiazides to cause hypokalemia. Therefore, the correct action for the nurse to take is to hold the digoxin and notify the provider. Administering the medications without addressing the potential toxicity could worsen the patient's condition. Requesting serum electrolytes (Choice A) may be necessary but holding the digoxin takes priority. Evaluating serum blood glucose (Choice B) is not relevant to the current situation. Holding hydrochlorothiazide (Choice D) is not the best option as the primary concern is the digoxin toxicity that needs to be addressed promptly.

2. A client with cardiovascular disease is scheduled to receive a daily dose of furosemide (Lasix). Which potassium level would cause the nurse to contact the physician before administering the dose?

• A. 3.0 mEq/L
• B. 3.8 mEq/L
• C. 4.2 mEq/L
• D. 5.1 mEq/L

Correct answer: A

Rationale: The normal serum potassium level in adults ranges from 3.5 to 5.1 mEq/L. A potassium level of 3.0 mEq/L is low, indicating hypokalemia and necessitating physician notification before administering furosemide, a loop diuretic that can further lower potassium levels. Potassium levels of 3.8 and 4.2 mEq/L are within the normal range, while a level of 5.1 mEq/L is high (hyperkalemia), but the critical value in this case is the low potassium level that requires immediate attention to prevent potential complications.

3. In a patient with diabetes mellitus, which of the following is a sign of hypoglycemia?

• A. Polydipsia.
• B. Polyuria.
• C. Sweating.
• D. Dry skin.

Correct answer: C

Rationale: Sweating is a common sign of hypoglycemia in diabetic patients. When blood sugar levels drop too low, the body releases stress hormones like adrenaline, which can cause sweating as a response to the perceived danger. Polydipsia (excessive thirst) and polyuria (excessive urination) are actually more commonly associated with hyperglycemia, not hypoglycemia. Dry skin is not typically a sign of hypoglycemia.

4. A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet?

• A. He visits his diabetic brother who just had surgery to amputate an infected foot.
• B. He is provided with the most current information about the dangers of untreated diabetes.
• C. He comments on the community service announcements about preventing complications associated with diabetes.
• D. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet.

Correct answer: A

Rationale: According to the Health Belief Model, the most effective event to increase compliance with the prescribed diet for a middle-aged male client with diabetes is experiencing a significant consequence related to the disease. In this case, visiting his diabetic brother who just had surgery to amputate an infected foot would serve as a strong 'cue to action,' increasing the client's perceived seriousness of the disease. This event is likely to have a more immediate and impactful effect on the client than other options. Option B provides valuable information but may not have the same personal and emotional impact as witnessing a severe consequence firsthand. Option C involves indirect exposure to prevention messages, which might not be as compelling as a direct experience. Option D, while supportive, does not present a direct consequence of non-compliance like option A does.

5. An adult client is admitted with flank pain and is diagnosed with acute pyelonephritis. What is the priority nursing action?

• A. Monitor hemoglobin and hematocrit
• B. Encourage turning and deep breathing
• C. Administer IV antibiotics as prescribed
• D. Auscultate for presence of bowel sounds

Correct answer: C

Rationale: The priority nursing action for a client diagnosed with acute pyelonephritis is to administer IV antibiotics as prescribed. Acute pyelonephritis is a serious kidney infection that requires prompt antibiotic therapy to prevent systemic complications and worsening of the infection. While monitoring hemoglobin and hematocrit (Choice A) is important, it is not the priority in the acute phase of infection. Encouraging turning and deep breathing (Choice B) and auscultating for bowel sounds (Choice D) are relevant aspects of care but do not take precedence over initiating antibiotic treatment to address the infection promptly.

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