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 male client expresses concern about how a hypophysectomy will affect his sexual function. Which of the following statements provides the most accurate information about the physiologic effects of hypophysectomy?

• A. Removing the source of excess hormone should restore the client's libido, erectile function, and fertility.
• B. Potency will be restored, but the client will remain infertile.
• C. Fertility will be restored, but impotence and decreased libido will persist.
• D. Exogenous hormones will be needed to restore erectile function after the adenoma is removed.

Correct answer: A

Rationale: Choice A is the most accurate statement regarding the physiologic effects of hypophysectomy on sexual function. The client's sexual problems are directly related to excessive hormone levels. Removing the source of excess hormone secretion through hypophysectomy should allow the client to return to a normal physiologic pattern, which includes restoring libido, erectile function, and fertility. Choices B, C, and D are incorrect. Choice B incorrectly states that the client will remain infertile, which is not necessarily true after a hypophysectomy. Choice C inaccurately suggests that fertility will be restored while impotence and decreased libido will persist, which is not aligned with the expected outcomes of hypophysectomy. Choice D is incorrect because exogenous hormones are typically not needed to restore erectile function after the adenoma is removed; rather, the removal of the source of excessive hormone secretion should address the sexual function concerns.

3. In a patient with asthma, which of the following is the most important indicator of respiratory function?

• A. Oxygen saturation.
• B. Respiratory rate.
• C. Arterial blood gases.
• D. Peak expiratory flow rate.

Correct answer: D

Rationale: The peak expiratory flow rate is the most important indicator of respiratory function in asthma because it measures how quickly air can be exhaled, reflecting the severity of airflow limitation. Oxygen saturation (Choice A) is important in assessing oxygenation, but it does not directly reflect respiratory function. Respiratory rate (Choice B) can provide information on breathing patterns but does not quantify airflow limitation. Arterial blood gases (Choice C) give information about gas exchange but are not as specific for assessing asthma control and severity as peak expiratory flow rate.

4. A client recovering from extracorporeal shock wave lithotripsy for renal calculi has an ecchymotic area on the right lower back. What action should the nurse take?

• A. Administer fresh-frozen plasma.
• B. Apply an ice pack to the site.
• C. Place the client in the prone position.
• D. Obtain serum coagulation test results.

Correct answer: B

Rationale: After extracorporeal shock wave lithotripsy, ecchymosis can occur due to bleeding into the tissues from the shock waves. Applying an ice pack helps reduce the extent and discomfort of bruising. Administering fresh-frozen plasma and obtaining coagulation test results are not necessary as ecchymosis after this procedure is common and does not indicate a bleeding disorder that requires immediate intervention. Placing the client in the prone position will not address the bleeding or bruising in this situation.

5. A client who is scheduled for cardiac catheterization to rule out coronary occlusion should be informed by the nurse that:

• A. The procedure is performed in a darkened room in the radiology department
• B. It is necessary to lie quietly on a hard x-ray table for about 4 hours
• C. The room is bright and well lit, and it is best to keep the eyes closed
• D. The client may have feelings of warmth or flushing during the procedure

Correct answer: D

Rationale: Before cardiac catheterization, the nurse should inform the client that the procedure is performed in a darkened room in the radiology department, not the operating room. The client should expect to lie still on an x-ray table for the duration of the procedure, not necessarily for about 4 hours. Keeping the eyes closed is not necessary as the room is usually dimly lit. The client may experience sensations of warmth or flushing during the procedure due to catheter passage and dye injection, making choice D the correct answer.

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