Nursing Elites

1. A patient with rheumatoid arthritis is prescribed methotrexate. What is an important teaching point for the nurse to provide?

• A. Take folic acid supplements as prescribed.
• B. Avoid alcohol completely.
• C. Expect to see immediate results.
• D. Limit fluid intake to 1 liter per day.

Correct answer: A

Rationale: The correct teaching point for a patient prescribed methotrexate is to take folic acid supplements as prescribed. Methotrexate can lead to a folate deficiency, which is why supplementing with folic acid is essential to reduce the risk of side effects such as mouth sores, nausea, and liver problems.

2. A client with cirrhosis of the liver is being cared for by the healthcare team. Which clinical manifestation indicates that the client has developed hepatic encephalopathy?

• A. Asterixis.
• B. Jaundice.
• C. Ascites.
• D. Splenomegaly.

Correct answer: A

Rationale: Asterixis, also known as flapping tremor, is a characteristic sign of hepatic encephalopathy, a severe complication of liver cirrhosis. Hepatic encephalopathy results from the liver's inability to detoxify substances in the body, leading to neurologic manifestations such as changes in mental status, confusion, and asterixis.

3. What should be monitored to evaluate the effectiveness of enoxaparin in a patient with deep vein thrombosis (DVT)?

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

Correct answer: C

Rationale: The international normalized ratio (INR) is the appropriate parameter to monitor the effectiveness of enoxaparin in preventing clot formation in patients with deep vein thrombosis (DVT). INR reflects the clotting ability of the blood and is commonly used to assess the therapeutic range of anticoagulant medications, such as enoxaparin, which is crucial in managing and preventing thrombotic events like DVT.

4. A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which instruction should the nurse include in the client's discharge teaching?

• A. Report any signs of infection, such as sore throat or fever, to your healthcare provider.'
• B. Increase your intake of iodine-rich foods, such as seafood and dairy products.'
• C. Take the medication on an empty stomach for better absorption.'
• D. You may experience weight gain and fatigue as side effects of the medication.'

Correct answer: A

Rationale: Propylthiouracil (PTU) can suppress bone marrow function, increasing the risk of infection, so it is important to report signs of infection promptly.

5. A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

• A. Alterations in glucose metabolism
• B. Retention of bile salts
• C. Inadequate production of albumin by hepatocytes
• D. Inability of the liver to use vitamin K

Correct answer: D

Rationale: The correct answer is D. The liver's inability to use vitamin K is the most likely factor contributing to the loss of prothrombin synthesis in liver failure. Vitamin K is essential for the synthesis of prothrombin, a crucial clotting factor. In liver failure, impaired utilization of vitamin K leads to decreased production of prothrombin, increasing the risk of bleeding in affected individuals.

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