Nursing Elites

1. Which of the following drugs has a therapeutic effect that increases cardiac output and slows heart rate?

• A. Heparin
• B. Alprazolam
• C. Digoxin
• D. Levothyroxine

Correct answer: C

Rationale: Digoxin is the correct answer. It is a medication known for its positive inotropic effects, which increase cardiac output, and negative chronotropic effects, which slow the heart rate. These effects are achieved by inhibiting the sodium-potassium ATPase pump in myocardial cells. Therefore, Digoxin is commonly prescribed to manage conditions like heart failure and atrial fibrillation, where enhancing cardiac output and reducing heart rate are beneficial. Choices A, B, and D are incorrect because Heparin is an anticoagulant, Alprazolam is a benzodiazepine used for anxiety disorders, and Levothyroxine is a thyroid hormone replacement drug, none of which have the specified therapeutic effects on cardiac function.

2. A healthcare provider is preparing to administer a transfusion of a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?

• A. Ensure that the client has a patent IV line before obtaining the blood product from the refrigerator.
• B. Obtain help from another healthcare provider to confirm the correct client and blood product.
• C. Take a complete set of vital signs before beginning the transfusion and periodically during the transfusion.
• D. Stay with the client for the first 15 to 30 minutes of the transfusion.

Correct answer: B

Rationale: The correct answer is to obtain help from another healthcare provider to confirm the correct client and blood product. This action is crucial in preventing an acute hemolytic reaction, which is caused by ABO or Rh incompatibility. Verifying the correct client and blood product before the transfusion ensures that there are no errors in identification, reducing the risk of a potentially life-threatening reaction. Choices A, C, and D are important aspects of transfusion safety but are not directly related to preventing acute hemolytic reactions. Ensuring a patent IV line, monitoring vital signs, and staying with the client are all essential during transfusion but do not specifically address the risk of ABO or Rh incompatibility reactions.

3. A client has a new prescription for Verapamil to control hypertension. Which of the following instructions should the nurse include?

• A. Increase the amount of dietary fiber in the diet.
• B. Drink grapefruit juice daily to increase vitamin C intake.
• C. Decrease the amount of calcium in the diet.
• D. Withhold food for 1 hr after taking the medication.

Correct answer: A

Rationale: Increasing dietary fiber intake is essential when taking Verapamil to prevent constipation, a common adverse effect of the medication. Dietary fiber can help maintain bowel regularity and alleviate constipation.

4. Why is it important to monitor ins and outs in patients using ACE inhibitors?

• A. To assess for renal impairment
• B. To ensure the patient is receiving adequate fluid intake
• C. To assess the patient for potential heart failure
• D. To assess for NSAID use

Correct answer: A

Rationale: It is crucial to monitor ins and outs in patients using ACE inhibitors to assess for renal impairment. ACE inhibitors can affect renal function, potentially leading to renal impairment. Monitoring the patient's fluid balance helps in early recognition of any renal issues and allows for timely interventions to prevent complications.

5. A client with Addison's disease is being admitted for a total hip arthroplasty. The client takes hydrocortisone. What is the nurse's priority action?

• A. Administering a supplemental dose of hydrocortisone
• B. Instructing the client about coughing and deep breathing
• C. Collecting additional information from the client about his history of Addison's disease
• D. Inserting an indwelling urinary catheter

Correct answer: A

Rationale: The priority action for a client with Addison's disease undergoing surgery who takes hydrocortisone is to administer a supplemental dose of hydrocortisone. Acute adrenal insufficiency (adrenal crisis) is a significant risk during surgery due to the stress placed on the body. Supplemental doses help prevent acute adrenal insufficiency and ensure the client's safety during the surgical procedure. Instructing the client about coughing and deep breathing is important post-operatively but not the priority before surgery. Collecting additional information about the client's history of Addison's disease is relevant but not the priority action before surgery. Inserting an indwelling urinary catheter is not the priority action in this scenario.

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