Nursing Elites

1. A client is admitted to the hospital with a venous stasis leg ulcer. The nurse inspects the ulcer expecting to note which observation?

• A. The ulcer has a pale-colored base.
• B. The ulcer is deep, with even edges.
• C. The ulcer has little granulation tissue.
• D. The ulcer has a brownish or 'brawny' appearance.

Correct answer: D

Rationale: When assessing a venous stasis leg ulcer, the nurse should expect to note a brownish or 'brawny' appearance. This discoloration is often due to hemosiderin deposits. The correct answer is not A because venous stasis ulcers typically do not have a pale-colored base. Choice B is incorrect as venous stasis ulcers usually have irregular, shallow edges, not deep and even edges. Choice C is incorrect as venous stasis ulcers often have excess granulation tissue, not little granulation tissue. Recognizing the brownish or 'brawny' appearance is crucial for accurate diagnosis and appropriate treatment of venous stasis leg ulcers.

2. A client has a new prescription for heparin. Which of the following laboratory results should be monitored to evaluate the effectiveness of the medication?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Platelet count

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory result that should be monitored to evaluate the effectiveness of heparin. Heparin works by prolonging the aPTT, and monitoring this parameter helps ensure the medication's effectiveness and safety in preventing clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor the effectiveness of warfarin, another anticoagulant. Platelet count is essential to assess platelet function and clotting disorders, but it is not specifically used to monitor heparin therapy.

3. A client has a new prescription for verapamil. Which of the following beverages should the client avoid while taking this medication?

• A. Orange juice
• B. Coffee
• C. Milk
• D. Grapefruit juice

Correct answer: D

Rationale: Grapefruit juice should be avoided while taking verapamil as it can increase drug levels and the risk of side effects. The interaction between grapefruit juice and verapamil can lead to higher concentrations of the medication in the bloodstream, potentially causing adverse effects. Orange juice, coffee, and milk do not have significant interactions with verapamil. Therefore, it is crucial for the client to avoid grapefruit juice to ensure the safe and effective use of verapamil.

4. When educating a client about the use of risedronate to treat osteoporosis, which instruction should be included?

• A. Drink a full glass of water with each dose.
• B. Take the medication on an empty stomach.
• C. Remain upright for 30 minutes after taking the medication.
• D. Avoid lying down for at least 1 hour after taking the medication.

Correct answer: C

Rationale: The correct instruction for a client taking risedronate to treat osteoporosis is to remain upright for 30 minutes after taking the medication. This is important to prevent esophageal irritation, as risedronate can cause irritation if it remains in contact with the esophagus. By staying upright, the medication is more likely to reach the stomach quickly and reduce the risk of irritation to the esophagus. Choices A, B, and D are incorrect. Drinking a full glass of water is recommended, not milk, to help with swallowing the medication. Risedronate should be taken on an empty stomach, not with meals, to ensure proper absorption. Additionally, avoiding lying down for at least 1 hour after taking the medication helps prevent esophageal irritation.

5. A client with hypertension is prescribed a thiazide diuretic. What instruction should the nurse reinforce to the client?

• A. Take the medication in the morning.
• B. Increase potassium intake in the diet.
• C. Weigh yourself daily.
• D. Limit fluid intake to 2 liters per day.

Correct answer: C

Rationale: The correct answer is to weigh oneself daily. This instruction is important as daily weights help monitor fluid loss and are crucial for detecting early signs of fluid imbalance when taking a diuretic. Weighing daily allows for timely adjustments in treatment and helps prevent complications associated with fluid imbalance. Choice A is not directly related to the client's need for monitoring fluid balance. Choice B, although important for some diuretics, is not specific to thiazide diuretics. Choice D is not appropriate as limiting fluid intake without proper monitoring can lead to dehydration, especially when taking diuretics.

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