Nursing Elites

1. A client with a diagnosis of acute myocardial infarction (MI) is receiving thrombolytic therapy. The nurse monitors the client for which potential complication associated with this therapy?

• A. Hypertension
• B. Bleeding
• C. Hyperkalemia
• D. Hypoglycemia

Correct answer: B

Rationale: Thrombolytic therapy is associated with an increased risk of bleeding due to its mechanism of action in dissolving blood clots. Therefore, the nurse should closely monitor the client for any signs of hemorrhage, such as unexplained bruising, bleeding gums, or blood in the urine or stools. Hypertension is not a common complication of thrombolytic therapy. Hyperkalemia and hypoglycemia are also not typically associated with this therapy.

2. A client has a new prescription for enalapril. Which of the following instructions should the nurse include?

• A. Monitor for a dry cough.
• B. Take the medication at bedtime.
• C. Avoid consuming grapefruit juice.
• D. Take the medication with food.

Correct answer: A

Rationale: The correct answer is A: Monitor for a dry cough. When a client is prescribed enalapril, it is important to monitor for a dry cough because it can be a side effect that indicates a potential issue like angioedema. This side effect needs close attention as it may require discontinuation of the medication to prevent further complications. Choices B, C, and D are incorrect because enalapril does not need to be taken at bedtime, does not interact with grapefruit juice, and can be taken without regard to meals.

3. The LPN/LVN is assisting with the care of a client who has been diagnosed with a myocardial infarction (MI). Which laboratory test result would the nurse expect to see elevated within the first 24 hours of the client's admission?

• A. Serum troponin
• B. Serum creatinine
• C. Serum sodium
• D. Serum albumin

Correct answer: A

Rationale: Elevated serum troponin levels are indicative of myocardial damage and are commonly used as a diagnostic marker for myocardial infarction. Troponin levels typically rise within a few hours of an MI and remain elevated for several days, making it a crucial test for early detection and monitoring of cardiac injury. Serum creatinine is not typically elevated in the acute phase of a myocardial infarction. Serum sodium and serum albumin levels are not directly associated with myocardial infarction and are unlikely to be elevated in the first 24 hours following an MI.

4. A client has a new prescription for nitroglycerin. Which of the following instructions should the nurse include?

• A. Store the medication in a cool, dry place.
• B. Take the medication as directed by the healthcare provider.
• C. Take the medication 30 minutes before meals.
• D. Take the medication at the first sign of chest pain.

Correct answer: D

Rationale: Instructing the client to take nitroglycerin at the first sign of chest pain is crucial for immediate relief of angina symptoms. Nitroglycerin is a fast-acting medication that helps dilate blood vessels, improving blood flow to the heart muscle. Therefore, prompt administration at the onset of chest pain is essential to alleviate anginal episodes effectively. Choices A, B, and C are incorrect because storing the medication properly, taking it as directed, or before meals are not specific instructions for managing acute anginal episodes, which require immediate action for symptom relief.

5. A client who has a new prescription for warfarin is being educated by a healthcare professional about monitoring for adverse effects. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should use a soft toothbrush to brush my teeth.'
• B. 'I will double my dose if I miss one.'
• C. 'I should increase my intake of leafy green vegetables.'
• D. 'I will contact my doctor if I notice any unusual bleeding or bruising.'

Correct answer: D

Rationale: The correct answer is D: 'I will contact my doctor if I notice any unusual bleeding or bruising.' This statement indicates a good understanding of the teaching regarding warfarin. Warfarin is an anticoagulant medication that increases the risk of bleeding. Contacting the doctor if unusual bleeding or bruising is noticed is essential as it can help prevent serious complications. Choices A, B, and C are incorrect. Using a soft toothbrush is generally recommended for oral hygiene but is not directly related to monitoring for adverse effects of warfarin. Doubling the dose of warfarin if a dose is missed is dangerous and can increase the risk of bleeding. Increasing the intake of leafy green vegetables can interfere with warfarin's effectiveness as they contain vitamin K, which antagonizes warfarin's anticoagulant effects.

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