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Questions 158

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Question 1 of 5

The nurse is preparing to administer digoxin (Lanoxin) to a client with heart failure. The client’s heart rate is 58 beats per minute. What is the nurse’s best action?

Correct Answer: B

Rationale: A heart rate of 58 bpm is below the threshold (60 bpm) for digoxin administration, as it may worsen bradycardia. Holding the dose and notifying the physician (
B) is safest. Administering (
A), reducing (
C), or delaying (
D) is inappropriate.

Question 2 of 5

A 25-year-old lawyer who is married with three young children works long hours in an effort to become a partner in the law firm. Following a recent hospitalization for a bleeding ulcer, he was referred for therapy to treat this psychophysiological disorder. On meeting with the therapist, he informed him or her that he was a busy man and did not have much time for this 'psych stuff.' When guiding the client to ventilate his feelings, the therapist can expect him to express feelings of:

Correct Answer: D

Rationale: Repressed anger is associated with psychophysiological disorders like a bleeding ulcer, as stress and unexpressed emotions contribute to physical symptoms.

Question 3 of 5

The nurse is caring for a client with a history of a seizure disorder who is receiving Carbamazepine (Tegretol). The nurse should monitor the client for:

Correct Answer: A

Rationale: Carbamazepine can cause leukopenia, requiring monitoring of white blood cell counts. Hypotension, hyperglycemia, and weight gain are not primary side effects.

Question 4 of 5

The client is admitted with a diagnosis of acute renal failure. Which laboratory value is most expected?

Correct Answer: A

Rationale: Elevated creatinine is a hallmark of acute renal failure, reflecting impaired kidney filtration. Hyperkalemia, decreased hemoglobin, and elevated BUN are more common than low potassium or BUN.

Question 5 of 5

A vaginal exam of a laboring client reveals that the fetus is at 0 station. This assessment means that:

Correct Answer: C

Rationale: A 0 station means the presenting part of the fetus is level with the ischial spines indicating engagement in the pelvis. It does not indicate a lack of descent transverse lie or immediate risk of precipitate delivery.

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