Nursing Elites

1. A client's plasma Lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?

• A. Perform immediate gastric lavage.
• B. Prepare the client for hemodialysis.
• C. Administer an additional oral dose of lithium.
• D. Request a stat repeat of the laboratory test.

Correct answer: A

Rationale: In a client with a plasma lithium level of 2.1 mEq/L, immediate gastric lavage is appropriate for severe toxicity. Gastric lavage can help lower the client's lithium level by removing the unabsorbed lithium from the stomach.

2. A healthcare professional is preparing to administer Enoxaparin to a client. Which of the following actions should the healthcare professional take?

• A. Administer the medication orally.
• B. Massage the injection site after administration.
• C. Insert the needle at a 45- to 90-degree angle.
• D. Aspirate before injecting the medication.

Correct answer: C

Rationale: Enoxaparin should be administered subcutaneously at a 45- to 90-degree angle. This angle ensures proper delivery of the medication. Massaging the injection site should be avoided to prevent bruising and possible tissue damage. Aspiration is not required for subcutaneous injections like Enoxaparin. Therefore, the correct action for administering Enoxaparin is to insert the needle at a 45- to 90-degree angle.

3. A client is receiving heparin therapy. Which laboratory value should be monitored by the nurse to evaluate the effectiveness of the therapy?

• A. PT
• B. aPTT
• C. INR
• D. Platelet count

Correct answer: B

Rationale: The activated partial thromboplastin time (aPTT) is specifically used to monitor the effectiveness of heparin therapy. It should be maintained at 1.5 to 2 times the normal level. Monitoring aPTT helps ensure that the therapeutic range of heparin is achieved to prevent clot formation while minimizing the risk of bleeding complications. Choice A (PT) is incorrect as it is used to monitor warfarin therapy, not heparin. Choice C (INR) is also incorrect as it is primarily used to monitor warfarin therapy. Choice D (Platelet count) is not directly related to monitoring the effectiveness of heparin therapy.

4. What is an expected outcome for Lithium use in patients with bipolar disorder?

• A. Reduced risk of myocardial infarction
• B. Reduced risk of GI ulcers
• C. Decrease in respiratory distress
• D. Decreased incidence of acute manic episodes

Correct answer: D

Rationale: The correct answer is D: Decreased incidence of acute manic episodes. Lithium is commonly used to treat bipolar disorder by helping to stabilize mood and reduce the intensity and frequency of manic episodes. This leads to better overall management of the disorder. Choices A, B, and C are incorrect because lithium is not known to reduce the risk of myocardial infarction, GI ulcers, or respiratory distress in patients with bipolar disorder.

5. A client has a prescription for Clonidine to treat hypertension. Which of the following instructions should the nurse include?

• A. Discontinue the medication if you experience dry mouth.
• B. Take the medication at the same time each day.
• C. Double the dose if you miss a dose.
• D. Avoid drinking orange juice while taking this medication.

Correct answer: B

Rationale: Correct Answer: Taking Clonidine at the same time each day is crucial to ensure consistent blood levels and effectively manage blood pressure. Consistency in timing helps optimize the medication's effectiveness in controlling hypertension.

Similar Questions