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A client with a history of deep vein thrombosis is prescribed enoxaparin. The nurse should monitor for which potential adverse effect?
- A. Increased risk of bleeding
- B. Decreased risk of bleeding
- C. Increased risk of infection
- D. Decreased risk of infection
Correct Answer: A
Rationale: Enoxaparin is an anticoagulant that works by preventing blood clots. One of the potential adverse effects of enoxaparin is an increased risk of bleeding due to its anticoagulant properties. Therefore, the nurse should monitor the client for signs of bleeding, such as easy bruising, petechiae, or blood in stool or urine, to ensure timely intervention and prevent complications.
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A client with heart failure develops hyperaldosteronism. What dietary recommendation is essential for managing this condition?
- A. Limit intake of high potassium foods
- B. Replace salt with salt substitute
- C. Monitor skin for excessive bruising
- D. Cover your skin before going outside
Correct Answer: A
Rationale: Hyperaldosteronism can lead to increased potassium retention, which can be problematic for individuals with heart failure. Limiting intake of high potassium foods is crucial to prevent hyperkalemia, a condition that can worsen heart failure. Therefore, advising the client to limit high potassium foods is essential in managing hyperaldosteronism in the setting of heart failure.
The healthcare provider has administered albuterol as an inhaled medication. The healthcare provider should monitor the client for which possible adverse reaction?
- A. Enuresis
- B. Lethargy
- C. Depression
- D. Tachycardia
Correct Answer: D
Rationale: Albuterol is a bronchodilator in the adrenergic category. Its actions and adverse effects are similar to adrenaline or epinephrine. The healthcare provider should monitor the client for tachycardia, which is a common adverse effect of albuterol due to its stimulant effect on beta-2 receptors. Enuresis, or night bed-wetting, is not an adverse effect associated with albuterol. Additionally, the client should be monitored for anxiety as a potential adverse effect, not lethargy or depression, which are not typically associated with albuterol administration.
A client is prescribed clopidogrel. The nurse should monitor for which potential side effect of this medication?
- A. Nausea and vomiting
- B. Bleeding or bruising
- C. Gastrointestinal bleeding
- D. Fatigue
Correct Answer: C
Rationale: When a client is prescribed clopidogrel, the nurse should monitor for potential side effects related to bleeding due to its antiplatelet effect. Gastrointestinal bleeding is a severe side effect associated with clopidogrel use. Monitoring for signs of gastrointestinal bleeding, such as black, tarry stools or vomiting blood, is essential to prevent serious complications.
A client with a history of stroke is prescribed clopidogrel. The nurse should monitor for which potential side effect?
- A. Bleeding
- B. Weight gain
- C. Nausea
- D. Headache
Correct Answer: A
Rationale: When a client with a history of stroke is prescribed clopidogrel, the nurse should monitor for potential side effects, especially bleeding. Clopidogrel is an antiplatelet medication that works by preventing blood clots. One of the major risks associated with clopidogrel is an increased tendency to bleed. Therefore, monitoring for signs of bleeding, such as easy bruising, blood in stool or urine, or prolonged bleeding from minor cuts, is crucial to ensure patient safety and early intervention if needed.
The practical nurse is assigned a client on digoxin therapy. Which finding is likely to predispose this client to developing digoxin toxicity?
- A. Hyponatremia
- B. Hypernatremia
- C. Hyperkalemia
- D. Hypokalemia
Correct Answer: D
Rationale: Hypokalemia predisposes a client on digoxin to digoxin toxicity. Symptoms of digoxin toxicity include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Therefore, assessment of serum potassium levels and prompt correction of hypokalemia are crucial interventions for clients taking digoxin.