Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who is taking digoxin to treat heart failure. Which of the following factors predisposes this client to developing digoxin toxicity?
A. Taking an HMG CoA reductase inhibitor.
Choice A is wrong because taking an HMG CoA reductase inhibitor (also called a statin) does not increase the risk of digoxin toxicity. Statins are lipid-lowering medications used to prevent coronary heart disease by blocking an enzyme involved in cholesterol synthesis. Statins do not affect the blood potassium level or the sensitivity of the heart to digoxin.
B. Having a 10-year history of COPD.
Choice B is wrong because having a 10-year history of COPD (chronic obstructive pulmonary disease) does not increase the risk of digoxin toxicity. COPD is a lung condition that causes breathing difficulties and chronic inflammation. COPD does not affect the blood potassium level or the sensitivity of the heart to digoxin.
C. Taking a high-ceiling diuretic.
Taking a high-ceiling diuretic predisposes this client to developing digoxin toxicity because it can cause hypokalemia (low blood potassium level), which increases the sensitivity of the heart to digoxin. Digoxin is a medicine that is used to treat heart failure or arrhythmias (abnormal heart rhythms) by increasing cardiac contractility and controlling the heart rate. Digoxin toxicity happens when there is too much digoxin in the body and it becomes harmful, causing symptoms such as nausea, vomiting, headache, confusion, vision disturbance, and irregular heartbeat.
D. Having a prolapsed mitral valve.
Choice D is wrong because having a prolapsed mitral valve does not increase the risk of digoxin toxicity. A prolapsed mitral valve is a condition where the valve between the left atrium and left ventricle of the heart does not close properly, allowing some blood to leak back into the atrium. A prolapsed mitral valve does not affect the blood potassium level or the sensitivity of the heart to digoxin.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
Taking a high-ceiling diuretic predisposes this client to developing digoxin toxicity because it can cause hypokalemia (low blood potassium level), which increases the sensitivity of the heart to digoxin. Digoxin is a medicine that is used to treat heart failure or arrhythmias (abnormal heart rhythms) by increasing cardiac contractility and controlling the heart rate. Digoxin toxicity happens when there is too much digoxin in the body and it becomes harmful, causing symptoms such as nausea, vomiting, headache, confusion, vision disturbance, and irregular heartbeat.
Choice A is wrong because taking an HMG CoA reductase inhibitor (also called a statin) does not increase the risk of digoxin toxicity.
Statins are lipid-lowering medications used to prevent coronary heart disease by blocking an enzyme involved in cholesterol synthesis.
Statins do not affect the blood potassium level or the sensitivity of the heart to digoxin.
Choice B is wrong because having a 10-year history of COPD (chronic obstructive pulmonary disease) does not increase the risk of digoxin toxicity. COPD is a lung condition that causes breathing difficulties and chronic inflammation.
COPD does not affect the blood potassium level or the sensitivity of the heart to digoxin.
Choice D is wrong because having a prolapsed mitral valve does not increase the risk of digoxin toxicity.
A prolapsed mitral valve is a condition where the valve between the left atrium and left ventricle of the heart does not close properly, allowing some blood to leak back into the atrium.
A prolapsed mitral valve does not affect the blood potassium level or the sensitivity of the heart to digoxin.
Similar Questions
A nurse is teaching a client who has pernicious anemia to self-administer nasal cyanocobalamin.
Which of the following information should the nurse include in the teaching?
A. Plan to self-administer this medication for the next 6 months.
Choice A is wrong because the duration of treatment depends on the individual’s response and blood levels of vitamin B. Some people may need to use this medication for longer than 6 months.
B. Administer the medication into one nostril once per week.
This is the recommended dosage for cyanocobalamin nasal spray for pernicious anemia and vitamin B12 deficiency. Cyanocobalamin nasal gel is used to prevent a lack of vitamin B12 that may be caused by various factors.
C. Lie down for 1 hour after administering the medication.
Choice C is wrong because there is no need to lie down for 1 hour after administering the medication. This may cause nasal irritation or drainage.
D. Use a nasal decongestant 15 minutes before the medication if you have a stuffy nose.
Choice D is wrong because using a nasal decongestant 15 minutes before the medication may interfere with the absorption of cyanocobalamin. If you have a stuffy nose, you should talk to your doctor about alternative ways to take vitamin B.
Full Explanation
This is the recommended dosage for cyanocobalamin nasal spray for pernicious anaemia and vitamin B12 deficiency. Cyanocobalamin nasal gel is used to prevent a lack of vitamin B12 that may be caused by various factors.
Choice A is wrong because the duration of treatment depends on the individual’s response and blood levels of vitamin B. Some people may need to use this medication for longer than 6 months.
Choice C is wrong because there is no need to lie down for 1 hour after administering the medication.
This may cause nasal irritation or drainage.
Choice D is wrong because using a nasal decongestant 15 minutes before the medication may interfere with the absorption of cyanocobalamin. If you have a stuffy nose, you should talk to your doctor about alternative ways to take vitamin B.
A nurse is assessing a client who has hypermagnesemia.
Which of the following medications should the nurse prepare to administer?
A. Calcium gluconate.
Calcium gluconate is used to treat hypermagnesemia because it can help calm some symptoms such as impaired breathing, irregular heartbeat, and hypotension. Calcium also helps normalize the neuromuscular function that is affected by excess magnesium.
B. Acetylcysteine.
Acetylcysteine is wrong because it is used to treat acetaminophen overdose and prevent kidney damage from contrast dye. It has no role in treating hypermagnesemia.
C. Flumazenil.
Flumazenil is wrong because it is used to reverse the effects of benzodiazepines, a class of sedative drugs. It has no role in treating hypermagnesemia.
D. Protamine sulfate.
Protamine sulfate is wrong because it is used to reverse the effects of heparin, an anticoagulant drug. It has no role in treating hypermagnesemia. Normal ranges for magnesium are 1.7 to 2.3 mg/dL or 0.7 to 1.1 mmol/L. Hypermagnesemia is defined as a magnesium level above 2.6 mg/dL or 1.5 mmol/L.
Full Explanation
Calcium gluconate is used to treat hypermagnesemia because it can help calm some symptoms such as impaired breathing, irregular heartbeat, and hypotension. Calcium also helps normalize the neuromuscular function that is affected by excess magnesium.
Choice B. Acetylcysteine is wrong because it is used to treat acetaminophen overdose and prevent kidney damage from contrast dye.
It has no role in treating hypermagnesemia.
Choice C. Flumazenil is wrong because it is used to reverse the effects of benzodiazepines, a class of sedative drugs.
It has no role in treating hypermagnesemia.
Choice D. Protamine sulfate is wrong because it is used to reverse the effects of heparin, an anticoagulant drug.
It has no role in treating hypermagnesemia.
Normal ranges for magnesium are 1.7 to 2.3 mg/dL or 0.7 to 1.1 mmol/L. Hypermagnesemia is defined as a magnesium level above 2.6 mg/dL or 1.5 mmol/L.
A nurse is assessing for allergies with a client who is scheduled to receive the influenza vaccine.
Which of the following allergies should the nurse report to the provider as a possible contraindication to receiving the vaccine?
A. Shellfish.
Choice A is wrong because shellfish is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.
B. Eggs.
According to the CDC, people with severe, life-threatening allergies to any ingredient in a flu vaccine (other than egg proteins) should not get that vaccine. However, people with egg allergy can get a flu vaccine. The CDC also states that people who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. Therefore, a nurse should report an egg allergy to the provider as a possible contraindication to receiving the vaccine.
C. Milk.
Choice C is wrong because milk is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.
D. Peanuts.
Choice D is wrong because peanuts are not an ingredient in a flu vaccine and are not a contraindication to receiving the vaccine.
Full Explanation
According to the CDC, people with severe, life-threatening allergies to any ingredient in a flu vaccine (other than egg proteins) should not get that vaccine. However, people with egg allergy can get a flu vaccine. The CDC also states that people who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. Therefore, a nurse should report an egg allergy to the provider as a possible contraindication to receiving the vaccine.
Choice A is wrong because shellfish is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.
Choice C is wrong because milk is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.
Choice D is wrong because peanuts are not an ingredient in a flu vaccine and are not a contraindication to receiving the vaccine.
