Nursing Elites

1. Which term conceptualizes that the greater the myocardial fiber stretch, within physiologic limits, the more forceful the ventricular contraction, thereby increasing stroke volume?

• A. Frank-Starling’s Law
• B. Automaticity
• C. Contractility
• D. Excitability

Correct answer: A

Rationale: The correct answer is A, Frank-Starling’s Law. This law explains that within physiologic limits, the greater the stretch of myocardial fibers, the more forceful the ventricular contraction, leading to an increased stroke volume. Choice B, Automaticity, refers to the ability of cardiac cells to spontaneously generate electrical impulses. Choice C, Contractility, represents the intrinsic ability of the heart muscle to contract. Choice D, Excitability, refers to the ability of cardiac cells to respond to electrical stimuli.

2. The client on warfarin has an INR of 5.5. What is the priority nursing action?

• A. Administer vitamin K as an antidote.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Administer fresh frozen plasma.

Correct answer: A

Rationale: An INR of 5.5 is significantly elevated, indicating an increased risk of bleeding. The priority nursing action in this situation is to administer vitamin K as an antidote to reverse the effects of warfarin and lower the INR. Holding the next dose of warfarin (choice B) is important but not as immediate as administering vitamin K. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the bleeding risk. Administering fresh frozen plasma (choice D) is not the first-line treatment for high INR due to warfarin.

3. 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.

4. What is the condition where the blood vessels that supply blood to the legs and feet become narrowed or blocked, causing pain and difficulty walking?

• A. Peripheral artery disease
• B. Raynaud's disease
• C. Varicose veins
• D. Pulmonary embolism

Correct answer: A

Rationale: The correct answer is A, Peripheral artery disease (PAD). PAD is a condition where the blood vessels that supply blood to the legs and feet become narrowed or blocked, leading to decreased blood flow, pain, and difficulty walking, especially during physical activity. Raynaud's disease (choice B) is characterized by vasospasms in the fingers and toes, causing them to turn white or blue. Varicose veins (choice C) are enlarged, twisted veins usually found in the legs. Pulmonary embolism (choice D) is a blockage in one of the pulmonary arteries in the lungs, often caused by a blood clot.

5. The client on nitroglycerin patches reports dizziness when standing up. What is the nurse’s best response?

• A. Advise the client to rise slowly to prevent dizziness.
• B. Instruct the client to discontinue the nitroglycerin patches.
• C. Encourage the client to rest and avoid physical activity.
• D. Suggest the client take an over-the-counter antiemetic.

Correct answer: A

Rationale: The correct answer is to advise the client to rise slowly to prevent dizziness. Dizziness when standing up can be a sign of orthostatic hypotension, a common side effect of nitroglycerin. Rising slowly can help minimize this symptom. Instructing the client to discontinue the nitroglycerin patches (Choice B) is not appropriate without consulting a healthcare provider as sudden discontinuation can lead to adverse effects. Encouraging the client to rest and avoid physical activity (Choice C) does not address the specific issue of orthostatic hypotension. Suggesting the client take an over-the-counter antiemetic (Choice D) is not indicated for dizziness related to orthostatic hypotension.

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