Nursing Elites

1. A client receiving warfarin (Coumadin) therapy should have which of the following laboratory results reviewed to evaluate the effectiveness of the therapy?

• A. Complete blood count (CBC).
• B. Prothrombin time (PT).
• C. International normalized ratio (INR).
• D. Partial thromboplastin time (PTT).

Correct answer: C

Rationale: The correct answer is C: International normalized ratio (INR). The INR is the most appropriate laboratory result to review when evaluating the effectiveness of warfarin (Coumadin) therapy. Warfarin is an anticoagulant medication, and the INR helps determine if the dosage is within a therapeutic range to prevent clotting or bleeding complications. Choice A, a Complete Blood Count (CBC), provides information about the cellular components of blood but does not directly assess the anticoagulant effects of warfarin. Choice B, Prothrombin time (PT), measures the time it takes for blood to clot but is not as specific for monitoring warfarin therapy as the INR. Choice D, Partial Thromboplastin Time (PTT), evaluates the intrinsic pathway of coagulation and is not the primary test used to monitor warfarin therapy.

2. The nurse is collecting information from a client with chronic pancreatitis who reports persistent gnawing abdominal pain. To help the client manage the pain, which assessment data is most important for the nurse to obtain?

• A. Presence and activity of bowel sounds
• B. Color and consistency of feces
• C. Eating patterns and dietary intake
• D. Level and amount of physical activity

Correct answer: C

Rationale: In chronic pancreatitis, managing abdominal pain is crucial, and assessing the client's eating patterns and dietary intake is essential. Dietary modifications can help alleviate symptoms and reduce the workload on the pancreas. Choices A, B, and D are not directly related to pain management in chronic pancreatitis. Bowel sounds, fecal characteristics, and physical activity may provide important information in other conditions but are not the priority in this scenario.

3. A client is being discharged after lithotripsy for a urinary calculus. Which statements should the nurse include in the discharge teaching? (Select all that apply.)

• A. Finish the prescribed antibiotic even if you are feeling better.
• B. Drink at least 3 liters of fluid each day.
• C. The bruising on your back may take several weeks to resolve.
• D. All of the above

Correct answer: D

Rationale: After lithotripsy for a urinary calculus, it is important for the client to complete the prescribed antibiotic course to prevent urinary tract infections. Drinking at least 3 liters of fluid daily helps dilute stone-forming crystals, prevent dehydration, and promote urine flow. Bruising on the back may occur after the procedure and can take several weeks to resolve. Additionally, the client may experience blood in the urine for several days post-procedure. Reporting any pain, fever, chills, or urination difficulties to the healthcare provider is essential, as these symptoms could indicate infection or stone formation. Choice D is correct as all the statements are appropriate for the client's discharge teaching. Choices A, B, and C are individually correct based on the rationale provided, making D the correct answer.

4. The healthcare provider is assessing a client undergoing peritoneal dialysis. Which of the following findings should be reported immediately to the physician?

• A. Clear dialysate outflow.
• B. Clear dialysate inflow.
• C. Cloudy dialysate outflow.
• D. Increased blood pressure.

Correct answer: C

Rationale: Cloudy dialysate outflow should be reported immediately to the physician as it is a concerning sign of peritonitis, a severe infection of the peritoneum. Peritonitis is a serious complication of peritoneal dialysis that requires prompt medical intervention to prevent further complications. Clear dialysate outflow and inflow are normal findings in peritoneal dialysis and do not indicate an immediate need for intervention. Increased blood pressure, while important to monitor, is not directly related to peritoneal dialysis and would not be the priority over the potentially life-threatening complication of peritonitis.

5. The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient being treated for a skin infection caused by Staphylococcus aureus. The patient has experienced nausea after several doses. What should the nurse do next?

• A. Administer the next dose when the patient has an empty stomach.
• B. Hold the next dose and contact the patient’s provider.
• C. Instruct the patient to take the next dose with a full glass of water.
• D. Request an order for an antacid to give along with the next dose.

Correct answer: C

Rationale: The correct action for the nurse to take next is to instruct the patient to take the next dose of clindamycin with a full glass of water. This is important to minimize gastrointestinal (GI) irritation such as nausea, vomiting, and stomatitis that the patient has been experiencing. Administering the medication on an empty stomach would likely worsen the GI upset. Holding the next dose and contacting the provider is not necessary at this point unless symptoms persist or worsen. Additionally, requesting an antacid is not indicated as the primary intervention for managing the nausea related to clindamycin.

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