Nursing Elites

1. A client with deep vein thrombosis has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

• A. Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.
• B. I will call the provider to get a prescription for discontinuing the IV heparin today.
• C. Both heparin and warfarin work together to dissolve the clots.
• D. The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay.

Correct answer: A

Rationale: The correct answer is A because warfarin takes several days to reach a therapeutic level and exert its full anticoagulant effect. During this time, the IV heparin is continued to prevent clotting until the warfarin is effective. Both medications are used together temporarily for this reason. Discontinuing heparin prematurely can increase the risk of clot formation. Therefore, the nurse should explain to the client that the IV heparin will be continued until the warfarin reaches a therapeutic level.

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

• A. Avoid drinking grapefruit juice.
• B. Take the medication with your evening meal.
• C. Increase your intake of leafy green vegetables.
• D. Stop taking the medication if you experience muscle pain.

Correct answer: A

Rationale: The correct answer is A: 'Avoid drinking grapefruit juice.' Grapefruit juice should be avoided when taking Atorvastatin because it can increase the blood levels of the medication, potentially leading to a higher risk of adverse effects like muscle pain and liver damage. It is important to follow this instruction to ensure the safe and effective use of Atorvastatin. Choices B, C, and D are incorrect. Taking Atorvastatin with food, specifically a low-fat meal, is recommended, but it is not necessary to specify the evening meal. While increasing intake of leafy green vegetables is generally beneficial for health, it is not a specific instruction for Atorvastatin. Lastly, stopping the medication if one experiences muscle pain is not advisable without consulting a healthcare provider, as muscle pain can be a symptom of a serious side effect of Atorvastatin that requires medical attention.

3. When a client has a new prescription for Warfarin, which of the following foods should they avoid based on the nurse's instructions?

• A. Broccoli
• B. Bananas
• C. Chicken
• D. Potatoes

Correct answer: A

Rationale: Clients prescribed Warfarin should avoid foods high in vitamin K, like broccoli, as they can counteract the medication's effectiveness. Warfarin works by inhibiting vitamin K-dependent clotting factors, so consuming high vitamin K foods can interfere with its anticoagulant effects. Bananas, chicken, and potatoes are not high in vitamin K and do not have a significant impact on Warfarin therapy.

4. A client is prescribed an IM dose of penicillin. The client reports developing a rash after taking penicillin 3 years ago. What should the nurse do?

• A. Administer the prescribed dose.
• B. Withhold the medication.
• C. Ask the provider to change the prescription to an oral form.
• D. Administer an oral antihistamine at the same time.

Correct answer: B

Rationale: The nurse should withhold the medication and inform the provider of the client's previous rash after taking penicillin. This history suggests a potential allergic reaction to penicillin, which can range from mild to severe anaphylaxis. Notifying the provider allows for an alternative antibiotic to be prescribed, considering the client's allergy to penicillin. It is crucial to avoid administering a medication that could potentially lead to a severe allergic reaction in the client. Administering the prescribed dose (Choice A) could be harmful due to the potential for an allergic reaction. Changing the prescription to an oral form (Choice C) does not address the underlying issue of a potential penicillin allergy. Administering an oral antihistamine (Choice D) without consulting the provider may not be sufficient to prevent a severe allergic reaction.

5. When administering medications to a 4-month-old infant, which of the following pharmacokinetic principles should be considered? (Select all that apply.)

• A. Infants have a more rapid gastric emptying time.
• B. Infants have immature liver function.
• C. Infants' blood-brain barrier is poorly developed.
• D. Infants have an increased ability to absorb topical medications.

Correct answer: B

Rationale: When administering medications to a 4-month-old infant, the pharmacokinetic principle to consider is that infants have immature liver function until 1 year of age. This requires medications metabolized by the liver to be administered in smaller dosages. While infants do have a more rapid gastric emptying time, immature liver function is a more critical pharmacokinetic consideration in this context. Additionally, although infants have a poorly developed blood-brain barrier, this relates more to pharmacodynamic effects rather than pharmacokinetic principles. The statement about infants having an increased ability to absorb topical medications is not directly related to pharmacokinetic principles, making choice B the correct answer.

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