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A nurse is caring for a client who is taking digoxin to treat heart failure. Which of the following predisposes this client to developing digoxin toxicity?
- A. Taking a high ceiling diuretic
- B. Having a 10-year history of COPD
- C. Having a prolapsed mitral valve
- D. Taking an HMG CoA reductase inhibitor
Correct Answer: A
Rationale: The correct answer is A: Taking a high ceiling diuretic. High ceiling diuretics, such as furosemide, can lead to hypokalemia, which increases the risk of digoxin toxicity. Digoxin competes with potassium for binding sites on the Na+/K+-ATPase pump in the heart, so low potassium levels can lead to an increased concentration of digoxin in the body, predisposing the client to toxicity. Choices B, C, and D are incorrect as they do not directly impact digoxin levels or toxicity. A history of COPD (B) or a prolapsed mitral valve (C) do not specifically predispose a client to digoxin toxicity. Taking an HMG CoA reductase inhibitor (D) does not interact directly with digoxin.
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A nurse is administering naloxone to a client who has developed an adverse reaction to morphine. The nurse should identify which of the following findings as a therapeutic effect of naloxone?
- A. Decreased nausea
- B. Increased pain relief
- C. Decreased blood pressure
- D. Increased respiratory rate
Correct Answer: D
Rationale: The correct answer is D: Increased respiratory rate. Naloxone is an opioid antagonist that works by blocking the effects of opioids, such as morphine. By administering naloxone to the client experiencing an adverse reaction to morphine, the nurse can reverse the respiratory depression caused by the morphine. This reversal leads to an increase in the client's respiratory rate, which is a therapeutic effect of naloxone in this situation.
Incorrect choices:
A: Decreased nausea - Naloxone does not directly address nausea.
B: Increased pain relief - Naloxone does not provide pain relief but reverses the effects of opioids.
C: Decreased blood pressure - Naloxone may lead to an increase in blood pressure due to its effects on reversing opioid-induced respiratory depression.
A nurse is caring for a client who has heart failure. The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?
- A. Potassium 3.8 mEq/L
- B. The client reports dizziness upon standing.
- C. The client reports difficulty hearing.
- D. BUN 15 mg/dL
Correct Answer: C
Rationale: The correct answer is C: The client reports difficulty hearing. Furosemide is a loop diuretic that can cause ototoxicity, leading to hearing loss. The nurse should notify the provider immediately to prevent further damage. A: Potassium level is within normal range. B: Dizziness upon standing can be expected due to volume loss. D: BUN level is normal and not a priority.
A nurse is reviewing the laboratory values of a client who is taking atorvastatin. Which of the following laboratory values indicates the treatment has been effective?
- A. BUN 15 mg/dL
- B. Blood glucose 90 mg/dL
- C. Urine specific gravity 1.020
- D. LDL 120 mg/dL
Correct Answer: D
Rationale: The correct answer is D: LDL 120 mg/dL. Atorvastatin is a medication used to lower LDL cholesterol levels. A decrease in LDL levels indicates the effectiveness of the treatment in reducing the risk of cardiovascular events. BUN, blood glucose, and urine specific gravity are not directly related to the effectiveness of atorvastatin in lowering cholesterol levels. BUN reflects kidney function, blood glucose monitors glucose levels, and urine specific gravity indicates hydration status. Therefore, D is the best indicator of treatment effectiveness.
A nurse is reviewing the laboratory results of a client who is taking amitriptyline. Which of the following laboratory values should the nurse report to the provider?
- A. Total bilirubin 1.5 mg/dL
- B. Potassium 4.2 mEq/L
- C. Hct 0.44%
- D. WBC count 5
Correct Answer: A
Rationale: The correct answer is A. Total bilirubin levels should be reported because amitriptyline can cause hepatotoxicity. Elevated bilirubin could indicate liver damage. Option B, potassium level, is not typically affected by amitriptyline. Option C, hematocrit, and option D, WBC count, are not directly related to amitriptyline use. Options E, F, and G are not provided. In summary, the nurse should report elevated total bilirubin levels due to potential hepatotoxicity from amitriptyline.
A home health nurse is visiting a client who has heart failure and a prescription for furosemide. The nurse identifies that the client has gained 2.5 kg (5 lb.) since the last visit 2 days ago. Which of the following actions should the nurse take first?
- A. Encourage the client to dangle the legs while sitting in a chair
- B. Teach the client about foods low in sodium
- C. Determine medication adherence by the client
- D. Notify the provider of the client's weight gain
Correct Answer: D
Rationale: The correct answer is D: Notify the provider of the client's weight gain. This is the first action the nurse should take because sudden weight gain in a client with heart failure could indicate fluid retention, which may worsen the client's condition. By notifying the provider, the nurse can ensure timely intervention to adjust the medication or treatment plan. Encouraging leg dangling (A) may help with circulation but does not address the immediate concern of weight gain. Teaching about low-sodium foods (B) is important for long-term management but not the priority at this moment. Determining medication adherence (C) is important but should come after addressing the immediate weight gain issue.