Nokea
A client with a history of heart failure is being discharged with a prescription for digoxin (Lanoxin). The nurse should include which instruction in the discharge teaching?
- A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute.
- B. Increase your fluid intake to at least 3 liters per day.
- C. Report any weight loss of more than 2 pounds in a week.
- D. Take the medication with meals to avoid gastrointestinal upset.
Correct Answer: A
Rationale: The correct instruction for discharge teaching regarding digoxin (Lanoxin) is to advise the client to take their pulse before each dose and to hold the medication if their pulse is below 60 beats per minute. Digoxin can cause bradycardia, so monitoring the pulse is crucial to prevent potential complications. Choice B is incorrect because excessive fluid intake can lead to fluid overload, worsening heart failure. Choice C is not directly related to digoxin therapy. Choice D is inaccurate as digoxin is usually taken on an empty stomach to facilitate absorption.
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What predisposing factor most likely contributed to the proximal end of the femur fracture in a 62-year-old woman who lives alone and tripped on a rug in her home?
- A. Failing eyesight leading to an unsafe environment
- B. Renal osteodystrophy from chronic kidney disease (CKD)
- C. Osteoporosis from declining hormone levels
- D. Cerebral vessel changes causing transient ischemic attacks
Correct Answer: C
Rationale: The most likely predisposing factor contributing to the proximal end of the femur fracture in a 62-year-old woman is osteoporosis resulting from declining hormone levels. Osteoporosis weakens the bones, making them more susceptible to fractures, especially in older adults, particularly women. In this case, the fracture can be attributed to the bone density loss associated with osteoporosis, which is a common concern in postmenopausal women. Choices A, B, and D are less likely to have directly contributed to the femur fracture in this scenario. Failing eyesight may increase the risk of falls but does not directly weaken the bones. Renal osteodystrophy affects bone health but is less common in this age group. Cerebral vessel changes causing transient ischemic attacks are related to vascular issues, not bone strength.
Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
- A. Protein malnutrition
- B. Iron-deficiency anemia
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: A
Rationale: Choice A is correct because phase I metabolism, involving cytochrome P450 enzymes, relies on protein for enzyme synthesis; malnutrition impairs this, reducing metabolism. Choice B is incorrect as iron deficiency affects oxygen transport, not directly phase I processes. Choice C is wrong since only protein malnutrition, not iron deficiency, is directly relevant. Choice D is incorrect because protein malnutrition does impact metabolism.
Food or drink that should be avoided when taking a prescription for simvastatin includes:
- A. Milk
- B. Orange juice
- C. Grapefruit juice
- D. Green leafy vegetables
Correct Answer: C
Rationale: Choice C is correct because grapefruit juice inhibits CYP3A4, which metabolizes simvastatin, increasing drug levels and rhabdomyolysis risk, so it's to be avoided. Choice A is incorrect as milk doesn't affect simvastatin significantly. Choice B is wrong because orange juice has no notable interaction. Choice D is incorrect since green leafy vegetables don't impact simvastatin metabolism.
The healthcare provider assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic?
- A. Tall, spiked T waves
- B. A prolonged QT interval
- C. A widening QRS complex
- D. Presence of a U wave
Correct Answer: D
Rationale: The presence of a U wave is often associated with hypokalemia, a possible side effect of diuretic therapy like furosemide. Hypokalemia can lead to U wave formation on an electrocardiogram, making the presence of U waves a concerning finding in clients taking diuretics. Tall, spiked T waves are typically seen in hyperkalemia, not hypokalemia. A prolonged QT interval is more commonly associated with conditions like Long QT syndrome or certain medications, not specifically with diuretics. A widening QRS complex is usually seen in conditions affecting the conduction system of the heart, such as bundle branch blocks, rather than being directly related to diuretic use.
When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
- A. The sum of the effects of each drug individually
- B. Greater than the sum of the effects of each drug individually
- C. Less than the effect of each drug individually
- D. Not predictable, as it varies with each individual
Correct Answer: B
Rationale: Choice B is correct because synergy means the combined effect exceeds the sum of individual effects, enhancing therapeutic outcomes beyond additive results. Choice A is incorrect as it describes an additive, not synergistic, effect. Choice C is wrong because synergy doesn't reduce efficacy below individual effects. Choice D is incorrect since synergy is a predictable pharmacological principle, not entirely variable.