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 client on warfarin has an INR of 4.5. What is the most appropriate action by the nurse?

• A. Administer vitamin K.
• 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 4.5 is elevated, indicating an increased risk of bleeding due to excessive anticoagulation. The most appropriate action for the nurse in this scenario is to administer vitamin K. Vitamin K helps reverse the anticoagulant effects of warfarin, thus lowering the INR and reducing the risk of bleeding. Holding the next dose of warfarin (choice B) is not sufficient to address the immediate high INR level. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the risk of bleeding. While monitoring the client's INR closely (choice D) is important, immediate action is required to address the critically high INR level, making the administration of vitamin K the priority intervention.

3. The client is on nitroglycerin patches. What should the nurse include in the client’s education?

• A. Rotate the application site with each new patch.
• B. Apply the patch at the same time each day.
• C. Leave the patch on for 24 hours, then remove it for 12 hours before applying a new one.
• D. Apply the patch to the same site each time.

Correct answer: A

Rationale: The correct answer is A: 'Rotate the application site with each new patch.' When educating a client using nitroglycerin patches, it is essential to rotate the application site to prevent skin irritation. Choice B is incorrect because applying the patch at the same time each day is not a critical aspect of patch application. Choice C is incorrect as nitroglycerin patches are usually left on for a specific period, typically 12 to 14 hours, before being replaced. Choice D is incorrect because applying the patch to the same site each time can lead to skin irritation and tolerance development.

4. What is a condition where the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients?

• A. Stroke
• B. Heart attack
• C. Pulmonary embolism
• D. Pneumonia

Correct answer: A

Rationale: A stroke occurs when the blood supply to part of the brain is interrupted or reduced, leading to brain cell death and potential disability. Choice B, a heart attack, involves a blockage in the blood vessels that supply the heart muscle. Choice C, a pulmonary embolism, is a blockage in one of the pulmonary arteries in the lungs. Choice D, pneumonia, is an infection that inflames the air sacs in one or both lungs.

5. Which disease is characterized by the damage to the alveoli in the lungs, leading to breathlessness?

• A. Emphysema
• B. Pulmonary fibrosis
• C. Lung cancer
• D. Lung abscess

Correct answer: A

Rationale: The correct answer is A, Emphysema. Emphysema is a lung condition characterized by the damage to the air sacs (alveoli) in the lungs, which results in breathlessness and reduced lung function. Pulmonary fibrosis (B) is a condition where lung tissue becomes damaged and scarred, leading to stiffness in the lungs. Lung cancer (C) is a malignancy affecting the lungs, which can cause various symptoms depending on the stage. Lung abscess (D) is a localized collection of pus within the lung tissue, typically caused by a bacterial infection.

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