The nurse is caring for a heart client on digoxin and notes a potassium level of 2.5. What is the appropriate priority nursing intervention?

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Cardiovascular System Exam Questions

Question 1 of 5

The nurse is caring for a heart client on digoxin and notes a potassium level of 2.5. What is the appropriate priority nursing intervention?

Correct Answer: C

Rationale: The correct answer is C because low potassium levels can increase the risk of digoxin toxicity. Digoxin and potassium have a reciprocal relationship, so low potassium levels can lead to digoxin toxicity. Checking the digoxin level is important to monitor for toxicity. A is incorrect because a potassium level of 2.5 is low and requires intervention. B is not the appropriate action as giving potassium without checking the digoxin levels first can worsen toxicity. D is incorrect because abruptly stopping digoxin can be harmful and should only be done under the guidance of a healthcare provider.

Question 2 of 5

The client on amiodarone develops pulmonary fibrosis. What action should the nurse take?

Correct Answer: A

Rationale: Step-by-step rationale: 1. Pulmonary fibrosis is a serious side effect of amiodarone. 2. Immediate notification of the healthcare provider is necessary to address this potentially life-threatening complication. 3. The healthcare provider will need to evaluate the client's condition, consider alternative treatments, and adjust the care plan accordingly. Summary of incorrect choices: B. Continuing the medication without intervention can worsen the pulmonary fibrosis. C. Discontinuing the medication is necessary, but oxygen therapy alone may not address the underlying issue. D. Reducing the dose may not be sufficient to manage the pulmonary fibrosis and delaying provider notification can lead to further complications.

Question 3 of 5

The client on spironolactone should avoid which of the following?

Correct Answer: A

Rationale: The correct answer is A: Foods high in potassium. Spironolactone is a potassium-sparing diuretic that can increase potassium levels in the body. Consuming foods high in potassium while taking spironolactone can lead to hyperkalemia, a serious condition characterized by high levels of potassium in the blood. The other choices (B: Foods high in sodium, C: Foods high in calcium, D: Foods high in chloride) are not directly contraindicated with spironolactone use. Sodium intake is typically restricted in patients taking diuretics, but it is not specifically related to spironolactone. Calcium and chloride levels are not significantly affected by spironolactone, so foods high in these minerals do not need to be avoided.

Question 4 of 5

The client on atorvastatin (Lipitor) should be advised to report which of the following symptoms?

Correct Answer: A

Rationale: The correct answer is A: Muscle pain. Atorvastatin can cause muscle pain as a side effect, which may progress to a serious condition called rhabdomyolysis. This requires immediate medical attention. Headache, nausea, and dizziness are less common side effects of atorvastatin and generally not as serious as muscle pain in this context. Reporting muscle pain promptly can help prevent complications and ensure appropriate management.

Question 5 of 5

When administering furosemide (Lasix) to a client, which lab value is most important to monitor?

Correct Answer: A

Rationale: The correct answer is A: Potassium. Furosemide is a loop diuretic that can cause potassium loss through increased urine output. Monitoring potassium levels is crucial to prevent hypokalemia, which can lead to serious cardiac arrhythmias. Sodium (B) and chloride (D) levels can also be affected by furosemide but are not as critical as potassium. Calcium (C) monitoring is not typically required when administering furosemide. By closely monitoring potassium levels, healthcare providers can prevent potential complications and ensure the safe administration of furosemide.

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