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. What test uses high-frequency sound waves to create images of the heart, allowing doctors to assess its structure and function?

• A. Echocardiogram
• B. MRI
• C. CT scan
• D. X-ray

Correct answer: A

Rationale: The correct answer is an echocardiogram. An echocardiogram utilizes high-frequency sound waves (ultrasound) to create images of the heart, enabling doctors to evaluate its structure, function, and detect any abnormalities. MRI (Choice B) uses magnetic fields and radio waves to produce detailed images of the body's structures. CT scan (Choice C) combines X-rays and computer technology to create cross-sectional images of the body. X-ray (Choice D) uses electromagnetic radiation to produce images of the internal structures of the body, but it is not the most suitable for assessing the heart's structure and function.

3. What is this surgical procedure that restores blood flow to the heart by diverting blood around a blocked artery?

• A. Coronary artery bypass graft (CABG)
• B. Angioplasty
• C. Stent placement
• D. Valve replacement

Correct answer: A

Rationale: The correct answer is A, Coronary artery bypass graft (CABG), which is a surgical procedure to improve blood flow to the heart by redirecting blood around blocked or narrowed arteries. This procedure is specifically designed to bypass blocked coronary arteries, allowing blood to flow more freely to the heart muscle. Choices B, C, and D are incorrect because angioplasty involves opening up narrowed or blocked blood vessels, stent placement involves inserting a mesh tube to keep arteries open, and valve replacement involves replacing a damaged heart valve - none of which directly address diverting blood flow around a blocked artery.

4. What is the primary effect of a calcium channel blocker on the heart?

• A. Decreases heart rate
• B. Increases heart rate
• C. Increases blood pressure
• D. Decreases blood pressure

Correct answer: D

Rationale: The correct answer is D: Decreases blood pressure. Calcium channel blockers primarily work by relaxing blood vessels, leading to a decrease in blood pressure. While these medications can have secondary effects on the heart, such as reducing the workload of the heart muscle, the primary effect related to blood pressure regulation. Therefore, choices A, B, and C are incorrect as they do not reflect the primary action of calcium channel blockers on the heart.

5. The nurse is caring for a client on warfarin with an INR of 5.2. What is the most appropriate action?

• A. Administer vitamin K as an antidote.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Monitor the client’s INR closely.

Correct answer: A

Rationale: An INR of 5.2 is elevated, indicating an increased risk of bleeding. Administering vitamin K can help reverse the effects of warfarin, which is the most appropriate action in this situation. Holding the next dose of warfarin is not enough to address the high INR, and increasing the dose would further elevate the INR level. Monitoring the INR closely is important, but in this case, immediate action is needed to counteract the anticoagulant effects of warfarin.

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