The nurse is caring for a patient with heart failure who is receiving lisinopril twice a day. What intervention will the nurse implement when administering this medication?

Hold medication if B-type natriuretic peptide (BNP) results are high.

Check serum potassium and creatinine levels.

Encourage the patient to add salt substitute with all meals.

Document extent of vision changes every shift.

Answer and Explanation

The Correct Answer is B

Choice A reason: Holding medication if B-type natriuretic peptide (BNP) results are high is not a standard intervention when administering lisinopril. BNP levels are used to assess the severity of heart failure, but they do not directly influence the administration of lisinopril. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that helps manage heart failure by reducing blood pressure and decreasing the workload on the heart.

Choice B reason: Checking serum potassium and creatinine levels is crucial when administering lisinopril. Lisinopril can affect kidney function and electrolyte balance. It may cause hyperkalaemia (elevated potassium levels) and increase serum creatinine levels, indicating impaired kidney function. Regular monitoring of these parameters helps ensure the patient's safety and the effectiveness of the medication.

Choice C reason: Encouraging the patient to add salt substitute with all meals is not recommended for patients taking lisinopril. Many salt substitutes contain potassium chloride, which can further increase the risk of hyperkalaemia in patients on ACE inhibitors like lisinopril. This intervention could lead to dangerous electrolyte imbalances.

Choice D reason: Documenting the extent of vision changes every shift is not related to the administration of lisinopril. Vision changes are not a common side effect of this medication. This intervention may be more relevant for patients on medications known to affect vision, but it is not specific to lisinopril.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A reason: Encouraging the patient to engage in moderate exercise to improve circulation is not appropriate during a sickle cell crisis. Exercise can increase oxygen demand and exacerbate the crisis. Rest and avoiding strenuous activities are recommended.

Choice B reason: Applying warm compresses to the painful areas can help reduce discomfort and improve circulation. Warmth helps relax muscles and dilate blood vessels, providing relief during a sickle cell crisis.

Choice C reason: Suggesting the patient drink caffeinated beverages to stay alert and energized is not appropriate. Caffeine can cause dehydration, which can worsen the sickling of red blood cells. Maintaining hydration with water and non-caffeinated beverages is essential.

Choice D reason: Recommending cold showers to help reduce pain and swelling is incorrect. Cold can cause vasoconstriction, which can worsen pain and reduce blood flow to affected areas. Warm compresses are preferred.

A. Acute hemolytic B. Allergic C. Anaphylactic D. Circulatory overload

Correct Answer is B

Explanation

Choice A reason: Acute hemolytic reactions are severe and typically present with symptoms such as fever, chills, flank pain, hemoglobinuria, and shock. The patient's mild symptoms of itching and a localized rash do not match the severe presentation of an acute hemolytic reaction.

Choice B reason: Allergic reactions to blood transfusions are common and usually present with symptoms such as itching, hives, and localized rash. The patient's vital signs and physical assessment showing mild itching and a rash on the arms are consistent with an allergic reaction.

Choice C reason: Anaphylactic reactions are severe allergic reactions that involve respiratory distress, hypotension, and shock. The patient's mild symptoms do not indicate an anaphylactic reaction.

Choice D reason: Circulatory overload presents with symptoms such as dyspnea, orthopnea, hypertension, and pulmonary edema. The patient's symptoms of itching and a rash do not align with circulatory overload.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is caring for a patient with heart failure who is receiving lisinopril twice a day. What intervention will the nurse implement when administering this medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a patient who is experiencing a sickle cell crisis about non-pharmacological interventions to help alleviate symptoms. Which of the following interventions will the nurse recommend?

Correct Answer is B

Explanation

The nurse is caring for a patient receiving packed red blood cells which started at 11:30 AM. The patient's vital signs and assessment findings are provided in the table below. What type of transfusion reaction will the nurse identify that the patient is experiencing?

Correct Answer is B

Explanation

The nursing students are preparing a care plan for a patient with heart failure. The patient will be prescribed diuretic therapy after discharge. What evidence-based instructions will the nurse include in this plan?

The nurse is caring for a patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), who has an order for a budesonide inhaler. When planning medication teaching, the nurse will plan to include which potential side effects of this medication? (Select All That Apply)

The nurse is caring for a patient with inflammatory bowel disease who has been discharged with an ileostomy. The patient expresses reluctance to participate in aspects of ostomy care. What is the nurse's most appropriate response to this observation?

The nurse is caring for a patient who is dyspneic with accessory muscle use, respiratory rate 24 breaths/minute, pulse oximetry 88% on room air, and speaking in phrases. When choosing an oxygen delivery system, which guideline is the most appropriate?

The nurse is caring for a patient with diabetes who is exhibiting signs and symptoms of peripheral neuropathy. What will the nurse identify as a risk for this patient?

The nurse is teaching the patient about the medication albuterol for the treatment of chronic obstructive pulmonary disease (COPD). Which medication adverse effect will the nurse teach the patient to monitor for and report?

The nurse is administering intravenous (IV) fluids to a patient undergoing hemodialysis. Which action is most important for the nurse to take to ensure patient safety during the procedure?

The nurse is monitoring a patient who is receiving a blood transfusion. The nurse identifies that the blood transfusion started over four hours ago. What intervention will the nurse implement next?