Nursing Elites

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

• A. Monitor for signs of bleeding.
• B. Avoid foods high in vitamin K.
• C. Expect to have increased urination.
• D. Take the medication with an antacid.

Correct answer: A

Rationale: The correct instruction for a client starting Warfarin is to monitor for signs of bleeding. Warfarin is an anticoagulant that increases the risk of bleeding; therefore, it is crucial for the client to watch for any signs of bleeding, such as easy bruising, prolonged bleeding from cuts, blood in urine or stools, or unusual bleeding from gums or nose. If any of these signs occur, the client should promptly report them to their healthcare provider for further evaluation and management. Choices B, C, and D are incorrect because avoiding foods high in vitamin K is related to other medications like Coumadin, increased urination is not a common side effect of Warfarin, and taking Warfarin with an antacid can potentially interfere with its absorption.

2. A client with thrombophlebitis receiving heparin by continuous IV infusion asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

• A. It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.
• B. A pharmacist is the person to answer that question.
• C. Heparin does not dissolve clots. It stops new clots from forming.
• D. The oral medication you will take after this IV will dissolve the clot.

Correct answer: C

Rationale: The correct response is C. Heparin does not dissolve clots; it prevents new clots from forming. Heparin works by inhibiting the formation of new clots and the extension of existing clots, rather than directly dissolving them. The client should be informed that the purpose of heparin therapy is to prevent the clot from getting larger and to reduce the risk of new clots forming. Choices A, B, and D are incorrect. Choice A talks about reaching a therapeutic blood level of heparin, which is not related to clot dissolution. Choice B deflects the question to a pharmacist without providing relevant information. Choice D inaccurately suggests that an oral medication will dissolve the clot, which is not the mechanism of action for heparin.

3. A client is being discharged with a new prescription for Metronidazole. Which of the following instructions should the nurse include?

• A. Avoid drinking alcohol while taking this medication.
• B. Take this medication on an empty stomach.
• C. Avoid dairy products while taking this medication.
• D. Take this medication with antacids.

Correct answer: A

Rationale: The correct instruction for a client prescribed Metronidazole is to avoid drinking alcohol while taking this medication. Consuming alcohol with Metronidazole can lead to a disulfiram-like reaction, causing symptoms such as nausea, vomiting, and flushing. It is crucial to advise clients to abstain from alcohol during the course of treatment to prevent adverse reactions and ensure the effectiveness of the medication.

4. A client is being educated by a healthcare provider about managing Digoxin toxicity. Which statement by the client demonstrates an understanding of the teaching?

• A. I will take an extra dose of Digoxin if I miss one.
• B. I should notify my healthcare provider if I experience visual changes.
• C. I will stop taking Digoxin if my heart rate is below 70 bpm.
• D. I should take antacids to alleviate gastrointestinal upset.

Correct answer: B

Rationale: The correct answer is B. Visual changes, such as yellow or blurred vision, can be indicative of digoxin toxicity. It is crucial for clients to inform their healthcare provider promptly if they encounter these symptoms. Prompt medical attention can help manage potential toxicity and prevent complications. Choices A, C, and D are incorrect because taking an extra dose of Digoxin, stopping Digoxin based on heart rate alone, and using antacids for gastrointestinal upset are not appropriate actions when managing Digoxin toxicity.

5. A client in the operating room received a dose of Succinylcholine, leading to muscle rigidity and a sudden rise in body temperature. The nurse should anticipate a prescription for which of the following medications?

• A. Neostigmine
• B. Naloxone
• C. Dantrolene
• D. Vecuronium

Correct answer: C

Rationale: Muscle rigidity and a sudden rise in temperature are indicative of malignant hyperthermia, a potential complication of succinylcholine. Dantrolene is the drug of choice to treat malignant hyperthermia as it acts on skeletal muscles to reduce metabolic activity and counteract the symptoms. Neostigmine (Choice A) is used to reverse the effects of non-depolarizing neuromuscular blocking agents, not for malignant hyperthermia. Naloxone (Choice B) is an opioid antagonist used for opioid overdose. Vecuronium (Choice D) is a non-depolarizing neuromuscular blocking agent and is not the appropriate medication for malignant hyperthermia.

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