Nokea
The nurse reviews newly prescribed laboratory tests and medications for the following clients. Which of the laboratory tests and prescriptions should the nurse question?
- A. Liver function tests (LFTs) for a client prescribed atorvastatin
- B. International normalized ratio (INR) for a client prescribed rivaroxaban
- C. Serum creatinine level for a client prescribed lisinopril
- D. Glycosylated hemoglobin (HgbA1C) level for a client prescribed olanzapine
Correct Answer: B
Rationale: INR monitoring is not typically required for rivaroxaban, a direct oral anticoagulant, as it does not affect INR. LFTs for atorvastatin, creatinine for lisinopril, and HgbA1C for olanzapine are appropriate monitoring tests.
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The nurse is administering prescribed furosemide to a client. Which of the following clinical manifestations would be consistent with the client developing fluid volume deficit? Select all that apply.
- A. tachycardia
- B. bradypnea
- C. weight gain
- D. decreased urine output
- E. tenting of the skin
Correct Answer: A,D,E
Rationale: Furosemide, a loop diuretic, can cause fluid volume deficit, leading to tachycardia (increased heart rate to compensate for reduced volume), decreased urine output (due to dehydration), and tenting of the skin (a sign of dehydration). Bradypnea and weight gain are not typical signs of fluid volume deficit.
The nurse is presenting at a staff development conference about medications used to treat heart failure. The nurse recognizes which medications are used to treat heart failure. Select all that apply.
- A. furosemide
- B. metformin
- C. lisinopril
- D. digoxin
- E. warfarin
- F. metoprolol
Correct Answer: A,C,D,F
Rationale: Furosemide (diuretic), lisinopril (ACE inhibitor), digoxin (cardiac glycoside), and metoprolol (beta-blocker) are used in heart failure. Metformin and warfarin are not standard treatments.
The nurse is assessing a client with systolic heart failure receiving prescribed carvedilol. Which of the following findings would indicate a therapeutic response?
- A. Increased urinary output
- B. Increased left-ventricular ejection fraction (EF)
- C. Increased left-ventricular remodeling
- D. Increased brain natriuretic peptide (BNP)
Correct Answer: B
Rationale: Carvedilol, a beta-blocker, improves left-ventricular ejection fraction in systolic heart failure, indicating a therapeutic response. Increased urinary output, remodeling, or BNP are not desired outcomes.
The nurse is caring for a client with an exacerbation of congestive heart failure (CHF). The client has generalized edema, dyspnea, and jugular venous distention. The nurse should anticipate a prescription for which medication?
- A. Mannitol
- B. Furosemide
- C. Diltiazem
- D. Verapamil
Correct Answer: B
Rationale: Furosemide, a loop diuretic, is used to treat fluid overload in CHF, addressing edema, dyspnea, and jugular venous distention. Mannitol, diltiazem, and verapamil are not appropriate.
The nurse is teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering beta-blockers?
- A. Atrial fibrillation
- B. Myocardial infarction
- C. Congestive heart failure (CHF)
- D. Cardiogenic shock
Correct Answer: D
Rationale: Cardiogenic shock is a contraindication for beta-blockers due to their negative inotropic effects, which can worsen cardiac output. Beta-blockers may be used cautiously in atrial fibrillation, myocardial infarction, or CHF.