Nursing Elites

1. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which laboratory value indicates a therapeutic effect of the medication?

• A. INR of 2.5.
• B. PTT of 45 seconds.
• C. Hemoglobin of 12 g/dL.
• D. Platelet count of 150,000/mm³.

Correct answer: A

Rationale: An INR (International Normalized Ratio) of 2.5 indicates a therapeutic level for clients receiving warfarin (Coumadin) to prevent thromboembolism. It is essential to monitor INR levels regularly when on warfarin therapy to ensure that the blood's ability to clot is within the desired range to prevent both clotting and excessive bleeding.

2. The client with chronic kidney disease (CKD) is receiving hemodialysis. Which finding should be reported to the healthcare provider immediately?

• A. Blood pressure of 150/90 mm Hg.
• B. Weight gain of 2 pounds since the last dialysis session.
• C. Blood glucose level of 120 mg/dl.
• D. Potassium level of 6.5 mEq/L.

Correct answer: D

Rationale: A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, which can lead to severe cardiac complications like arrhythmias and cardiac arrest. Immediate medical intervention is necessary to lower potassium levels to prevent life-threatening outcomes in clients undergoing hemodialysis.

3. A client with heart failure is prescribed furosemide (Lasix). Which instruction should the nurse include in the client's teaching plan?

• A. Take the medication before bedtime.
• B. Report any weight gain of more than 2 pounds in a day.
• C. Increase your intake of high-sodium foods.
• D. Limit your fluid intake to less than 1 liter per day.

Correct answer: B

Rationale: In heart failure, fluid retention is a concern. Furosemide helps manage this by promoting diuresis. Instructing the client to report weight gain exceeding 2 pounds in a day is crucial as it can indicate fluid accumulation, prompting timely intervention to prevent worsening heart failure symptoms and complications.

4. A client who delivered a 7-pound infant 12 hours ago is complaining of a severe headache. The client's blood pressure is 110/70, respiratory rate is 18 breaths/minute, heart rate is 74 beats/minute, and temperature is 98.6º F. The client's fundus is firm and one fingerbreadth above the umbilicus. What action should the healthcare team implement first?

• A. Notify the healthcare provider of the assessment findings.
• B. Determine if the client received anesthesia during delivery.
• C. Assign a licensed nurse to reassess the client's vital signs.
• D. Obtain a STAT hemoglobin and hematocrit.

Correct answer: B

Rationale: The correct action to implement first is to determine if the client received anesthesia during delivery. Anesthesia can be a potential cause of postpartum headaches. This information is crucial in assessing and managing the client's condition effectively before considering other interventions. It helps in identifying possible contributing factors to the client's complaint of a severe headache and guides the healthcare team in providing appropriate care and treatment.

5. For a patient with asthma, what is the primary purpose of prescribing salmeterol?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Suppress cough
• D. Thin respiratory secretions

Correct answer: B

Rationale: Salmeterol is classified as a long-acting beta2-agonist, which is used to prevent asthma attacks by providing extended bronchodilation. It is not typically used for immediate relief of acute bronchospasm or for suppressing cough. Additionally, salmeterol does not have the primary purpose of thinning respiratory secretions.

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