Nursing Elites

1. The client on warfarin has an INR of 1.2. What is the nurse’s priority action?

• A. Increase the dose of warfarin
• B. Administer vitamin K
• C. Monitor for signs of bleeding
• D. Hold the next dose and notify the healthcare provider

Correct answer: A

Rationale: The correct answer is to increase the dose of warfarin. An INR of 1.2 is below the therapeutic range for a client on warfarin, indicating that the dose is subtherapeutic. The priority action in this situation is to adjust the dose to achieve the target therapeutic INR range (usually 2-3) to prevent thromboembolic events. Administering vitamin K is not necessary as the INR is low, and there are no signs of bleeding. Monitoring for signs of bleeding is important but not the priority in this case since the INR is subtherapeutic. Holding the next dose and notifying the healthcare provider would delay the intervention needed to adjust the dose and achieve the therapeutic range.

2. The nurse is administering a beta blocker to a client with a heart rate of 50 bpm. What is the priority action?

• A. Hold the beta blocker and notify the healthcare provider.
• B. Administer the beta blocker as ordered.
• C. Decrease the dose of the beta blocker.
• D. Monitor the client’s heart rate and reassess in 30 minutes.

Correct answer: A

Rationale: The correct action is to hold the beta blocker and notify the healthcare provider. A heart rate of 50 bpm is already low, and beta blockers can further decrease the heart rate, potentially causing adverse effects like bradycardia or heart block. Administering the beta blocker as ordered (Choice B) can exacerbate the low heart rate. Decreasing the dose of the beta blocker (Choice C) may not be sufficient to address the potential harm. Monitoring the client’s heart rate and reassessing in 30 minutes (Choice D) may delay necessary interventions if the heart rate drops further. Therefore, the priority is to hold the medication and seek guidance from the healthcare provider.

3. The client on spironolactone should avoid which of the following?

• A. Foods high in potassium
• B. Foods high in sodium
• C. Foods high in calcium
• D. Foods high in chloride

Correct answer: A

Rationale: The correct answer is A: Foods high in potassium. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium and excrete sodium. Consuming foods high in potassium while on spironolactone can lead to an excess of potassium in the body, potentially causing hyperkalemia. Choices B, C, and D are incorrect because spironolactone does not directly interact with sodium, calcium, or chloride in a way that would require specific dietary restrictions related to these minerals.

4. Which test measures the electrical activity of the heart and can detect arrhythmias and other heart conditions?

• A. Electrocardiogram (ECG or EKG)
• B. Chest X-ray
• C. MRI
• D. CT scan

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG or EKG). An electrocardiogram is a test that measures the electrical activity of the heart and can detect arrhythmias and other heart conditions by recording the heart's electrical impulses. Choices B, C, and D are incorrect because a chest X-ray is used to visualize the structures in the chest, an MRI (Magnetic Resonance Imaging) is used to provide detailed images of organs and tissues, and a CT scan (Computed Tomography) is a type of imaging that uses X-rays to create detailed cross-sectional images of the body.

5. Which condition involves the body's immune system attacking the lungs and kidneys, causing severe respiratory and renal damage?

• A. Goodpasture syndrome
• B. Sarcoidosis
• C. Wegener's granulomatosis
• D. Interstitial lung disease

Correct answer: A

Rationale: Goodpasture syndrome is the correct answer. It is an autoimmune disease characterized by the immune system attacking the lungs and kidneys, leading to bleeding in the lungs and kidney failure. Sarcoidosis primarily affects the lungs and lymph nodes, not the kidneys. Wegener's granulomatosis affects the lungs, sinuses, and kidneys, but it is characterized by inflammation of blood vessels. Interstitial lung disease involves scarring of the lung tissue, not direct immune system attacks on the lungs and kidneys.

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