Nursing Elites

1. When teaching a client with a new prescription for spironolactone, which instruction should the nurse include?

• A. Increase your intake of potassium-rich foods.
• B. Avoid consuming grapefruit juice.
• C. Take the medication with food.
• D. Monitor for signs of hyperkalemia.

Correct answer: D

Rationale: The correct answer is to instruct the client to monitor for signs of hyperkalemia when taking spironolactone since it is a potassium-sparing diuretic. Hyperkalemia is a potential adverse effect due to the medication's mechanism of action. Advising the client to increase potassium-rich foods (Choice A) would be incorrect as it can further elevate potassium levels, which could lead to hyperkalemia. Avoiding grapefruit juice (Choice B) is not directly related to spironolactone use. Though taking the medication with food (Choice C) can help reduce gastrointestinal upset, it is not the most critical instruction when initiating spironolactone therapy.

2. The LPN/LVN is reinforcing instructions to a client on the use of a metered-dose inhaler. The nurse should recognize that the client is using the inhaler correctly if the client takes which action?

• A. Takes a deep breath and then exhales just before administration
• B. Holds the mouthpiece 1 to 2 inches from the mouth
• C. Inhales the medication and then exhales immediately after administration
• D. Performs 3 short inhalations and then exhales deeply after administration

Correct answer: A

Rationale: When using a metered-dose inhaler, the client should take a deep breath and then exhale just before administration. This technique helps ensure that the medication is inhaled effectively. By exhaling before administration, the client can fully inhale the medication into the lungs, maximizing its therapeutic effects. Choice B is incorrect because holding the mouthpiece 1 to 2 inches from the mouth is not a crucial step for using a metered-dose inhaler correctly. Choice C is incorrect because inhaling the medication and then exhaling immediately after administration would not allow the medication to be adequately absorbed into the lungs. Choice D is incorrect because performing 3 short inhalations and then exhaling deeply after administration is not the correct technique for using a metered-dose inhaler.

3. A client with deep vein thrombosis (DVT) is receiving anticoagulant therapy. The nurse should reinforce with the client the importance of reporting which potential side effect?

• A. Nausea
• B. Headache
• C. Gingival bleeding
• D. Dizziness

Correct answer: C

Rationale: The correct answer is C, 'Gingival bleeding.' Gingival bleeding is a common side effect of anticoagulant therapy. Anticoagulants work by prolonging the time it takes for blood to clot, which can lead to bleeding issues, including gingival bleeding. Nausea, headache, and dizziness are not typically associated with anticoagulant therapy. Since bleeding, including gingival bleeding, can be a serious side effect that requires medical attention, the client should be educated on reporting it promptly to their healthcare provider.

4. A client has a new prescription for heparin. Which of the following laboratory results should be monitored to evaluate the effectiveness of the medication?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Platelet count

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory result that should be monitored to evaluate the effectiveness of heparin. Heparin works by prolonging the aPTT, and monitoring this parameter helps ensure the medication's effectiveness and safety in preventing clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor the effectiveness of warfarin, another anticoagulant. Platelet count is essential to assess platelet function and clotting disorders, but it is not specifically used to monitor heparin therapy.

5. A client with a history of deep vein thrombosis (DVT) is prescribed warfarin (Coumadin). The nurse should include which instruction in the discharge teaching?

• A. Take the medication at the same time each day
• B. Avoid green leafy vegetables in your diet
• C. Increase your intake of vitamin K-rich foods
• D. Stop the medication if you notice any bruising

Correct answer: A

Rationale: Taking warfarin at the same time each day is crucial to maintain consistent blood levels and ensure the effectiveness of the medication in preventing clot formation. Consistent timing helps in monitoring and adjusting the dosage as needed to keep the international normalized ratio (INR) within the therapeutic range to prevent clotting events or excessive bleeding. Choices B, C, and D are incorrect. Avoiding green leafy vegetables is a misconception; while they are high in vitamin K which antagonizes warfarin, they should not be avoided but consumed in moderation. Increasing vitamin K-rich foods can interfere with warfarin's effectiveness. Stopping the medication due to bruising can be dangerous as it may indicate a clotting problem that the medication is intended to prevent.

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