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 has lost a significant amount of blood due to complications during surgery. What parameter does the nurse recognize as the earliest indication of new decreases in fluid volume?

• A. Pulse rate
• B. Blood pressure
• C. Pulmonary artery systolic pressure
• D. Pulmonary artery end-diastolic pressure

Correct answer: A

Rationale: The earliest indication of new decreases in fluid volume is often recognized by an increase in pulse rate. Cardiac output is influenced by circulating blood volume, heart pumping action, and vascular tone. As fluid volume decreases, the body compensates by increasing the pulse rate. The formula for cardiac output is pulse rate multiplied by stroke volume. An elevated pulse rate helps maintain blood pressure with minor volume depletion. Pulmonary artery systolic pressure and pulmonary artery end-diastolic pressure, obtained through a pulmonary artery catheter, provide insights into pulmonary artery and left ventricle pressures at the end of diastole. These parameters are not the earliest indicators of new decreases in fluid volume compared to pulse rate.

3. The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom?

• A. Dizziness
• B. Dysuria
• C. Nausea
• D. Tinnitus

Correct answer: D

Rationale: The correct answer is D: Tinnitus. When furosemide and an aminoglycoside antibiotic are used together, there is an increased risk of ototoxicity. Tinnitus, a ringing in the ears, is a common early sign of ototoxicity. Dizziness (choice A) is a common side effect of furosemide but not specifically related to this drug interaction. Dysuria (choice B) is painful urination and is not directly associated with this drug combination. Nausea (choice C) is a common side effect of furosemide but is not specifically indicative of ototoxicity caused by the drug interaction.

4. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?

• A. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.
• B. Continue the intravenous fluids as ordered and reassess the patient frequently.
• C. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.
• D. Stop the intravenous fluids and notify the provider of the assessment findings.

Correct answer: D

Rationale: The patient’s potassium level is within normal limits, but the decreased urine output indicates the patient should not receive additional IV potassium. Increasing potassium chloride to 40 mEq/L is not needed as the level is normal. Stopping the IV fluids is appropriate due to the decreased urine output, which suggests potential fluid overload. The nurse should notify the provider of the assessment findings for further management. Increasing the rate of fluids to 200 mL/hour is not recommended without addressing the decreased urine output first.

5. What is the priority intervention for a patient with a suspected myocardial infarction (MI)?

• A. Administering oxygen.
• B. Administering nitroglycerin.
• C. Administering aspirin.
• D. Administering morphine.

Correct answer: A

Rationale: Administering oxygen is the priority intervention for a patient with a suspected myocardial infarction to improve oxygenation. Oxygen helps ensure an adequate oxygen supply to the heart muscle, reducing the workload on the heart. Nitroglycerin and aspirin are important interventions in the treatment of MI; however, oxygen administration takes precedence to ensure adequate oxygenation. Morphine may be considered for pain relief, but it is not the initial priority in the treatment of a suspected MI.

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