Nursing Elites

1. A client who has a new prescription for warfarin is being educated by a healthcare professional about monitoring for adverse effects. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should use a soft toothbrush to brush my teeth.'
• B. 'I will double my dose if I miss one.'
• C. 'I should increase my intake of leafy green vegetables.'
• D. 'I will contact my doctor if I notice any unusual bleeding or bruising.'

Correct answer: D

Rationale: The correct answer is D: 'I will contact my doctor if I notice any unusual bleeding or bruising.' This statement indicates a good understanding of the teaching regarding warfarin. Warfarin is an anticoagulant medication that increases the risk of bleeding. Contacting the doctor if unusual bleeding or bruising is noticed is essential as it can help prevent serious complications. Choices A, B, and C are incorrect. Using a soft toothbrush is generally recommended for oral hygiene but is not directly related to monitoring for adverse effects of warfarin. Doubling the dose of warfarin if a dose is missed is dangerous and can increase the risk of bleeding. Increasing the intake of leafy green vegetables can interfere with warfarin's effectiveness as they contain vitamin K, which antagonizes warfarin's anticoagulant effects.

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

• A. Use the inhaler every 4 hours around the clock.
• B. Shake the inhaler well before use.
• C. Rinse your mouth with water after each use.
• D. Use the inhaler while lying down.

Correct answer: B

Rationale: Shaking the inhaler well before use is crucial as it helps ensure proper mixing of the medication, which is essential for effective delivery of the drug to the lungs. This step is important for optimal therapeutic effects of albuterol inhalation. Choices A, C, and D are incorrect. Using the inhaler every 4 hours around the clock without specifying a maximum number of doses can lead to overuse. Rinsing the mouth with water after each use is typically advised for inhaled corticosteroids to reduce the risk of oral thrush, not for albuterol. Using the inhaler while lying down is not recommended as it may lead to improper medication delivery to the lungs.

3. A client is admitted to the emergency department with a suspected myocardial infarction (MI). The nurse should prepare the client for which immediate diagnostic test?

• A. Chest x-ray
• B. Electrocardiogram (ECG)
• C. Echocardiogram
• D. Coronary angiography

Correct answer: B

Rationale: An Electrocardiogram (ECG) is the most immediate and essential test to diagnose a myocardial infarction (MI) and assess the extent of heart damage. An ECG can quickly identify changes in the heart's electrical activity, allowing prompt initiation of appropriate interventions. A chest x-ray (Choice A) may show other conditions affecting the heart, but it is not the immediate test of choice for diagnosing an MI. An echocardiogram (Choice C) and coronary angiography (Choice D) are valuable in further assessing cardiac function and anatomy post-MI but are not the first-line diagnostic tests due to their time-consuming nature compared to an ECG.

4. A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure is still stable, what should the nurse do next?

• A. Administer another nitroglycerin tablet.
• B. Apply 1 to 3 L/minute of oxygen via nasal cannula.
• C. Call for a 12-lead electrocardiogram (ECG) to be performed.
• D. Wait an additional 5 minutes, then give a second nitroglycerin tablet.

Correct answer: A

Rationale: When a client with angina pectoris continues to experience chest pain despite initial nitroglycerin administration and stable blood pressure, the appropriate next step is to administer another nitroglycerin tablet. This helps to further dilate coronary arteries, improving blood flow to the heart muscle and relieving chest pain. Applying oxygen via nasal cannula (Choice B) may be necessary if the client displays signs of respiratory distress or hypoxemia, but in this case, the priority is addressing the unresolved chest pain. Calling for a 12-lead electrocardiogram (ECG) (Choice C) is important to assess for any changes in the client's cardiac status, but administering another nitroglycerin tablet takes precedence in managing the ongoing chest pain. Waiting an additional 5 minutes before giving a second nitroglycerin tablet (Choice D) may delay symptom relief and potentially worsen the client's condition if the chest pain persists.

5. The client with chronic stable angina is prescribed a beta blocker. The nurse is reinforcing instructions. What instruction should the nurse include?

• A. Take the medication with a meal.
• B. Report a pulse rate below 60 beats per minute.
• C. Discontinue the medication if dizziness occurs.
• D. Avoid drinking grapefruit juice.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to report a pulse rate below 60 beats per minute. Beta blockers are known to lower heart rate, and a pulse rate below 60 beats per minute may indicate bradycardia, a condition that requires medical attention. Option A, 'Take the medication with a meal,' is incorrect because beta blockers don't necessarily need to be taken with food. Option C, 'Discontinue the medication if dizziness occurs,' is incorrect because abrupt cessation of beta blockers can lead to rebound hypertension and other adverse effects. Option D, 'Avoid drinking grapefruit juice,' is unrelated to beta blockers' mechanism of action or side effects.

Similar Questions