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The nurse is administering digoxin, a cardiac glycoside, to the client with congestive heart failure. Which interventions should the nurse implement? Select all that apply.
- A. Check the apical heart rate for one (1) full minute.
- B. Monitor the client's serum sodium level.
- C. Teach the client how to take his or her radial pulse.
- D. Evaluate the client's serum digoxin level.
- E. Assess the client for buffalo hump and moon face.
Correct Answer: A,C,D
Rationale: Checking apical HR prevents bradycardia, teaching pulse empowers monitoring, and digoxin levels ensure therapeutic range. Sodium or Cushingoid features are irrelevant.
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The nurse is hanging 1,000 mL of IV fluids to run for eight (8) hours. The intravenous tubing is a microdrip. How many gtt/min should the IV rate be set?
Correct Answer: 15
Rationale: Microdrip is 60 gtt/mL. Rate: (1,000 mL / 8 hr) x (60 gtt/mL / 60 min) = 125 mL/hr x 1 gtt/min = 15.625 gtt/min, rounded to 15 gtt/min.
The client with postmenopausal osteoporosis is prescribed the bisphosphonate alendronate (Fosamax). Which discharge instruction should the nurse discuss with the client?
- A. The medication must be taken with the breakfast meal only.
- B. Remain upright for at least 30 minutes after taking medication.
- C. The tablet should be chewed thoroughly before swallowing.
- D. Stress the importance of having monthly hormone levels.
Correct Answer: B
Rationale: Alendronate requires upright posture for 30 minutes post-dose to prevent esophageal irritation, per FDA guidelines. Meal timing, chewing, or hormone levels are incorrect.
A post-operative client has a prescription for acetaminophen with codeine. What should the nurse recognize as a primary effect of this combination?
- A. Enhanced pain relief
- B. Minimized side effects
- C. Prevention of drug tolerance
- D. Increased onset of action
Correct Answer: A
Rationale: Enhanced pain relief. Combination of analgesics with different mechanisms of action can afford greater pain relief.
A client confides in the RN that a friend has told her the medication she takes for depression, Wellbutrin, was taken off the market because it caused seizures. What is an appropriate response by the nurse?
- A. Ask your friend about the source of this information.'
- B. Omit the next doses until you talk with the doctor.'
- C. There were problems, but the recommended dose is changed.'
- D. Your health care provider knows the best drug for your condition.'
Correct Answer: C
Rationale: Wellbutrin was introduced in the U.S. in 1985 and then withdrawn because of the occurrence of seizures in some patients taking the drug. The drug was reintroduced in 1989 with specific recommendations regarding dose ranges to limit the occurrence of seizures. The risk of seizure appears to be strongly associated with dose.
Which of the following persons would be least likely to receive tetracycline?
- A. An adolescent with acne
- B. A woman with chlamydia who is seven months pregnant
- C. A 10-year-old child with Rocky Mountain spotted fever
- D. A 32-year-old man with walking pneumonia
Correct Answer: B
Rationale: Tetracycline can damage developing teeth in fetuses and children under 8, making the pregnant woman least likely to receive it.