Nursing Elites

1. A patient with coronary artery disease (CAD) is prescribed a statin medication. What should the nurse include in the patient education?

• A. Take the medication with food.
• B. Report any muscle pain or weakness.
• C. Increase intake of grapefruit juice.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: Patients prescribed statin medications should be educated to report any muscle pain or weakness to their healthcare provider promptly. Muscle pain or weakness could be a sign of rhabdomyolysis, a serious side effect associated with statin use that requires medical attention. Choices A, C, and D are incorrect. Taking statins with food or increasing grapefruit juice intake are not necessary recommendations. Avoiding foods high in potassium is also not directly related to statin use.

2. The client has acute kidney injury (AKI). Which assessment finding requires immediate intervention?

• A. Urine output of 50 ml in the last hour.
• B. Serum potassium of 6.2 mEq/L.
• C. Blood pressure of 150/90 mm Hg.
• D. Serum creatinine of 2.5 mg/dL.

Correct answer: B

Rationale: An elevated serum potassium level of 6.2 mEq/L in a client with AKI can lead to life-threatening cardiac arrhythmias, necessitating immediate intervention. Hyperkalemia is a serious complication in AKI as impaired kidney function can result in the accumulation of potassium in the blood, posing a risk of cardiac arrest. Prompt treatment to lower potassium levels is crucial to prevent cardiac complications in this situation.

3. What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?

• A. Proton-pump inhibitor
• B. Endoscopic balloon dilatation
• C. Sucralfate
• D. Esophageal resection

Correct answer: B

Rationale: The patient's presentation and radiologic findings are consistent with achalasia. The absence of a mass on upper endoscopy and CT scan helps rule out secondary causes. Achalasia is best managed with endoscopic balloon dilatation or myotomy. Proton-pump inhibitors are not effective for achalasia. Sucralfate is not a primary treatment for achalasia. Esophageal resection is only considered if malignancy develops. Patients with achalasia may experience chest pain and weight loss due to food accumulation in the dilated esophagus. Endoscopic balloon dilatation is a safe and effective treatment option for improving symptoms in achalasia patients.

4. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should the nurse monitor to determine the effectiveness of the medication?

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

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of warfarin (Coumadin) therapy. These tests help assess the clotting time and the desired anticoagulant effect of the medication. Monitoring PT and INR levels is crucial to ensure that the client is within the therapeutic range, reducing the risk of bleeding or clotting complications associated with warfarin therapy. Platelet count (Choice A) measures the number of platelets in the blood and is not specific for monitoring warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice C) is more commonly used to monitor heparin therapy, not warfarin. Fibrinogen level (Choice D) assesses the amount of fibrinogen in the blood and is not a specific test for monitoring warfarin therapy.

5. An elderly client with congestive heart failure (CHF) is admitted to the hospital. Which laboratory test result should the nurse expect to find?

• A. Elevated serum sodium level.
• B. Decreased brain natriuretic peptide (BNP) level.
• C. Increased serum creatinine level.
• D. Elevated hemoglobin and hematocrit levels.

Correct answer: C

Rationale: In clients with congestive heart failure (CHF), impaired cardiac function can lead to decreased renal perfusion, resulting in elevated serum creatinine levels. Therefore, an increased serum creatinine level is a common laboratory finding in CHF clients, indicating possible renal impairment.

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