Nursing Elites

1. A healthcare professional is assessing a client who has a new prescription for levothyroxine. Which of the following findings should the healthcare professional report to the provider?

• A. Weight gain
• B. Increased heart rate
• C. Heat intolerance
• D. Elevated blood pressure

Correct answer: C

Rationale: The correct answer is C: Heat intolerance. Heat intolerance is a concerning sign of levothyroxine toxicity and should be reported to the provider promptly. Levothyroxine is a medication used to treat hypothyroidism by supplementing the body's thyroid hormones. When a client experiences heat intolerance, it can indicate that the dose of levothyroxine is too high, leading to hyperthyroidism symptoms. Weight gain, increased heart rate, and elevated blood pressure are not typically associated with levothyroxine toxicity; instead, they are more commonly seen in conditions like hypothyroidism.

2. A healthcare provider is providing discharge instructions to a client who has a new prescription for warfarin. Which of the following statements should the healthcare provider include?

• A. Avoid using a soft toothbrush.
• B. Report any signs of bleeding.
• C. Increase your intake of leafy green vegetables.
• D. Take the medication with food.

Correct answer: B

Rationale: The correct answer is to instruct the client to report any signs of bleeding when taking warfarin. Warfarin is an anticoagulant medication that increases the risk of bleeding, so it is essential to monitor for any signs of abnormal bleeding and report them promptly for appropriate management. Choices A, C, and D are incorrect. Instructing the client to avoid using a soft toothbrush is not directly related to warfarin therapy. Increasing the intake of leafy green vegetables is not recommended as they contain vitamin K, which can interfere with warfarin's anticoagulant effects. Taking warfarin with food can be inconsistent and may not result in optimal absorption.

3. A client reports chest pain that is unrelieved by three doses of nitroglycerin taken 5 minutes apart. What is the nurse's next best action?

• A. Administer another dose of nitroglycerin.
• B. Call the healthcare provider immediately.
• C. Provide oxygen via nasal cannula.
• D. Place the client in a supine position.

Correct answer: B

Rationale: In the scenario described, the client's chest pain persists despite three doses of nitroglycerin, indicating a potentially severe cardiac issue like a myocardial infarction. The priority for the nurse in this situation is to involve the healthcare provider promptly. Calling the healthcare provider immediately is essential to ensure timely evaluation and appropriate intervention for the client. Administering more nitroglycerin without further assessment or instructions may not be safe and could delay necessary treatments. Providing oxygen or changing the client's position may offer some comfort but does not address the underlying potentially life-threatening condition, making these options less appropriate as the immediate next best action.

4. The client is receiving heparin therapy for deep vein thrombosis (DVT). Which lab test should be monitored to evaluate the effectiveness of heparin?

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

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the appropriate lab test to monitor the therapeutic effectiveness of heparin therapy. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure the client is within the therapeutic range to prevent clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, a different anticoagulant that affects the extrinsic pathway of the coagulation cascade. Fibrinogen levels are not specific to monitoring heparin therapy.

5. The LPN/LVN is assisting in the care of a client with chronic heart failure who is receiving furosemide (Lasix). Which instruction should the nurse reinforce with the client?

• A. Limit your fluid intake to avoid fluid overload.
• B. Increase your potassium intake by eating bananas and oranges.
• C. Weigh yourself once a week to monitor for fluid retention.
• D. Take the medication at night to avoid frequent urination during the day.

Correct answer: B

Rationale: The correct instruction for the nurse to reinforce with the client is to increase potassium intake by eating bananas and oranges. Furosemide can lead to potassium loss, potentially causing hypokalemia. By increasing potassium intake through diet, the client can help prevent this electrolyte imbalance and maintain overall health. Choices A, C, and D are incorrect. Limiting fluid intake is not the appropriate instruction, as furosemide is a diuretic that already helps in fluid management. Weighing once a week is not as crucial as monitoring potassium levels, and taking the medication at night does not impact potassium levels.

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