Nursing Elites

1. A client with a diagnosis of deep vein thrombosis (DVT) is receiving anticoagulation therapy. Which of the following laboratory values would be most concerning?

• A. INR of 1.5
• B. Platelet count of 200,000/mm³
• C. Hemoglobin of 12 g/dL
• D. aPTT of 70 seconds

Correct answer: A

Rationale: An INR of 1.5 is below the therapeutic range for clients on anticoagulation therapy, increasing the risk of clot formation. A lower INR indicates inadequate anticoagulation, which can lead to thrombus formation and potential complications such as progression or recurrence of deep vein thrombosis. Platelet count, hemoglobin level, and aPTT are important parameters to monitor in a client with DVT. However, in this scenario, the most concerning value is the suboptimal INR level because it signifies a lack of anticoagulation effectiveness and poses a higher risk of clotting issues.

2. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which instruction should the LPN/LVN reinforce to the client to help manage their condition?

• A. Increase fluid intake to thin secretions.
• B. Practice pursed-lip breathing to improve oxygenation.
• C. Avoid physical activity to prevent dyspnea.
• D. Use a peak flow meter to monitor lung function.

Correct answer: B

Rationale: Practicing pursed-lip breathing is an essential technique to help manage COPD as it can improve oxygenation by promoting better gas exchange. This technique helps to keep the airways open longer during exhalation, preventing air trapping and improving breathing efficiency. Increasing fluid intake can help thin secretions, which is beneficial, but it is not the primary instruction for managing COPD. Avoiding physical activity is not recommended as it can lead to deconditioning and worsen dyspnea in COPD patients. Using a peak flow meter is more commonly associated with monitoring asthma rather than COPD, so it is not the most relevant instruction for managing COPD.

3. A group member is being taught about expected changes of aging by a nurse. Which statement by the group member shows effective learning?

• A. ''I should expect my heart rate to take longer to return to normal after excessive exercise as I get older.''
• B. ''I should expect my vision to improve as I age.''
• C. ''I should expect my skin to become more elastic as I age.''
• D. ''I should expect my hearing to become more acute as I age.''

Correct answer: A

Rationale: Choice A is the correct answer because as individuals age, there is a normal decline in cardiac efficiency, leading to a slower return to baseline heart rate after exercise. This statement demonstrates an understanding of an expected change related to aging. Choice B is incorrect as vision typically declines with age due to changes in the eye's structure. Choice C is incorrect because aging usually leads to a decrease in skin elasticity. Choice D is incorrect as hearing tends to decline rather than become more acute with age.

4. A client is receiving discharge instructions for using a walker. Which statement indicates an understanding of the teaching?

• A. I will hire someone to trim the tree that hangs low over the stairs of my front porch.
• B. I will avoid using the walker on uneven surfaces.
• C. I will use the walker on stairs for added support.
• D. I will not need to make any changes to my home environment.

Correct answer: A

Rationale: The correct answer is A because hiring someone to trim low-hanging branches over stairs ensures home safety and reflects an understanding of walker use. This action indicates the client's awareness of potential hazards and the importance of a safe environment for walker use. Choice B is incorrect as avoiding uneven surfaces is a general safety precaution but does not directly relate to walker use and does not demonstrate an understanding of the teaching. Choice C is incorrect because using a walker on stairs is not recommended due to safety concerns such as balance and fall risks. Choice D is incorrect as making no changes to the home environment may pose safety risks when using a walker, showing a lack of understanding regarding safety precautions needed for walker use.

5. A nurse offers pain medication to a client who is postoperative before ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles?

• A. Fidelity
• B. Autonomy
• C. Justice
• D. Beneficence

Correct answer: D

Rationale: The correct answer is D: Beneficence. Beneficence involves actions intended to benefit the client, such as providing pain relief. In this scenario, the nurse is demonstrating beneficence by offering pain medication to alleviate the client's discomfort and promote their well-being. Fidelity (A) relates to being faithful to agreements and commitments, autonomy (B) refers to respecting a client's right to make decisions about their care, and justice (C) involves fairness and equal treatment. While these ethical principles are important in healthcare, the situation described primarily exemplifies the principle of beneficence.

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