Nursing Elites

1. A client with deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory test should the nurse monitor to assess the effectiveness of the therapy?

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

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the appropriate laboratory test to monitor the effectiveness of heparin therapy. Heparin works by prolonging the clotting time, which is reflected in the aPTT results. Monitoring aPTT helps ensure the patient is within the therapeutic range and not at risk of bleeding or clotting complications. Prothrombin time (PT) (Choice A) primarily measures the extrinsic pathway of coagulation and is used to monitor warfarin therapy, not heparin. Platelet count (Choice B) assesses the number of platelets present in the blood and is not specific to monitoring heparin therapy. International normalized ratio (INR) (Choice D) is used to monitor warfarin therapy, not heparin.

2. The community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?

• A. The mother who took her children from school because aliens were after them.
• B. The young man who has a history of substance abuse and no telephone.
• C. The newly diagnosed client who needs to be evaluated for medication compliance.
• D. The young woman who believes she is to blame for her recent miscarriage.

Correct answer: A

Rationale: The mother who took her children from school due to delusions of aliens poses a significant risk to her children and herself. This situation requires immediate attention to ensure the safety and well-being of all involved. Choice B is concerning due to the history of substance abuse, but the immediate risk to life and safety as in Choice A takes precedence. Choice C, although important, does not present an immediate danger as the delusional belief of aliens. Choice D, while emotionally distressing, does not pose an immediate threat as the situation described in Choice A.

3. During an assessment, a healthcare professional suspects a client has cholecystitis. What is a common symptom of this condition?

• A. Right upper quadrant pain
• B. Left lower quadrant pain
• C. Generalized abdominal pain
• D. Epigastric pain

Correct answer: A

Rationale: Right upper quadrant pain is a hallmark symptom of cholecystitis, indicating inflammation of the gallbladder. The gallbladder is typically located in the right upper quadrant of the abdomen, so pain in this area is characteristic of cholecystitis. This pain may be sharp or cramp-like and can be accompanied by other symptoms such as nausea, vomiting, and fever. Left lower quadrant pain (choice B) is more commonly associated with diverticulitis, generalized abdominal pain (choice C) can be seen in various conditions, and epigastric pain (choice D) is typically related to issues in the upper central part of the abdomen, such as gastritis or peptic ulcers, rather than cholecystitis.

4. What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?

• A. Proton-pump inhibitor
• B. Endoscopic balloon dilatation
• C. Sucralfate
• D. Esophageal resection

Correct answer: B

Rationale: The patient's presentation and radiologic findings are consistent with achalasia. The absence of a mass on upper endoscopy and CT scan helps rule out secondary causes. Achalasia is best managed with endoscopic balloon dilatation or myotomy. Proton-pump inhibitors are not effective for achalasia. Sucralfate is not a primary treatment for achalasia. Esophageal resection is only considered if malignancy develops. Patients with achalasia may experience chest pain and weight loss due to food accumulation in the dilated esophagus. Endoscopic balloon dilatation is a safe and effective treatment option for improving symptoms in achalasia patients.

5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which instruction should the nurse provide?

• A. Use oxygen continuously, even while sleeping.
• B. Adjust the oxygen flow rate to 5 liters per minute if short of breath.
• C. Report any signs of difficulty breathing immediately.
• D. Take off the oxygen while eating or drinking.

Correct answer: A

Rationale: The correct instruction for a client with COPD receiving oxygen therapy is to use oxygen continuously, even while sleeping. This is important to ensure adequate oxygenation and optimal respiratory function for clients with COPD. Continuous oxygen therapy helps maintain oxygen levels during sleep, which is crucial for individuals with COPD who may experience nighttime hypoxemia. Therefore, advising the client to use oxygen continuously, even during sleep, is essential in managing COPD and preventing complications associated with oxygen deprivation.

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