Nursing Elites

1. A patient is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

• A. Hemoglobin
• B. Prothrombin time (PT)
• C. Bleeding time
• D. Activated partial thromboplastin time (aPTT)

Correct answer: B

Rationale: The correct answer is to monitor Prothrombin time (PT) when a patient is on warfarin therapy. Warfarin affects blood clotting, and PT is used to assess the therapeutic effect of this medication. Hemoglobin (Choice A) is not directly affected by warfarin therapy and does not reflect its therapeutic effect. Bleeding time (Choice C) measures the time it takes for bleeding to stop after a standardized cut and is not specific to warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice D) is more commonly used to monitor heparin therapy, not warfarin.

2. A client with asthma has new prescriptions for cromolyn and albuterol by nebulizer. Which statement by the client indicates an understanding of the teaching?

• A. If my breathing begins to feel tight, I will use the cromolyn immediately.
• B. I will be sure to take the albuterol before taking the cromolyn.
• C. I will use both medications immediately after exercising.
• D. I will administer the medications 10 minutes apart.

Correct answer: B

Rationale: The correct answer is B. Taking albuterol before cromolyn ensures that the airways are open, allowing the cromolyn to reach the lungs effectively. Choice A is incorrect because cromolyn is a preventive medication and should be used regularly, not just when symptoms worsen. Choice C is incorrect because medications should be used as prescribed, not based on a specific event like exercising. Choice D is incorrect because there is no need to wait 10 minutes between administering these two medications when using a nebulizer.

3. A healthcare professional is reviewing the medication list of a client who has a new prescription for Digoxin to treat heart failure. Which of the following medications places the client at risk for Digoxin toxicity?

• A. Spironolactone
• B. Calcium channel blockers
• C. Loop diuretics
• D. ACE inhibitors

Correct answer: C

Rationale: Loop diuretics, such as Furosemide, can increase the risk of Digoxin toxicity by causing hypokalemia. Hypokalemia enhances the toxic effects of Digoxin on the heart, leading to an increased risk of Digoxin toxicity. Spironolactone (Choice A) is less likely to cause hypokalemia and does not significantly increase the risk of Digoxin toxicity. Calcium channel blockers (Choice B) and ACE inhibitors (Choice D) do not directly increase the risk of Digoxin toxicity through hypokalemia; therefore, they are not the medications that place the client at risk for Digoxin toxicity.

4. A healthcare professional is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of Enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the healthcare professional plan to take?

• A. Expel the air bubble from the prefilled syringe before injecting.
• B. Insert the needle completely into the client's tissue.
• C. Administer the injection in the client's thigh.
• D. Aspirate carefully after inserting the needle into the client's skin.

Correct answer: B

Rationale: Correct Answer: B. When administering enoxaparin, it is essential to insert the needle completely into the client's tissue to ensure a deep subcutaneous injection. This method helps in the appropriate delivery of the medication. Choice A is incorrect because expelling air bubbles is not necessary with subcutaneous injections and may lead to medication loss. Choice C is incorrect as enoxaparin is usually administered in the abdomen, not the thigh. Choice D is incorrect as aspiration is not recommended for subcutaneous injections to avoid trauma or bleeding.

5. When teaching the parents of a child who has a new prescription for Desipramine, which of the following adverse effects should the nurse instruct the parents is the priority to report to the provider?

• A. Constipation
• B. Suicidal thoughts
• C. Photophobia
• D. Dry mouth

Correct answer: B

Rationale: The priority adverse effect to report when a child is taking Desipramine is suicidal thoughts. Desipramine can lead to an increased risk of suicidal thoughts and behaviors. The nurse should emphasize to the parents the importance of monitoring the child for any signs of worsening depression or suicidal ideation. Prompt reporting of such symptoms can help prevent harm to the child. Choices A, C, and D are not the priority adverse effects associated with Desipramine. While constipation, photophobia, and dry mouth can occur as side effects of Desipramine, they are not as critical as the risk of suicidal thoughts, which requires immediate attention to ensure the safety of the child.

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