Nursing Elites

1. The client is taking interferon alfa-2a (Roferon-A) and ribavirin (Virazole) combination therapy for hepatitis C and reports overwhelming feelings of depression. Which action should the nurse implement first?

• A. Recommend mental health counseling.
• B. Review the medication actions and interactions.
• C. Assess the client's daily activity level.
• D. Provide information about a support group.

Correct answer: B

Rationale: The priority action for the nurse is to review the medication actions and interactions. Interferon alfa-2a and ribavirin combination therapy for hepatitis C can lead to neuropsychiatric side effects, including depression. By assessing the medication actions and interactions, the nurse can identify if the depression is a known side effect of the medications, and further intervention or adjustment of the treatment plan may be required to address the client's emotional well-being. Recommending mental health counseling (choice A) may be necessary but should come after ensuring that the depression is not solely caused by medication side effects. Assessing the client's daily activity level (choice C) and providing information about a support group (choice D) are important interventions but addressing the medication's potential contribution to the depression takes precedence.

2. Which laboratory test should be monitored to evaluate the effectiveness of anticoagulant therapy in a client with deep vein thrombosis (DVT)?

• A. Complete blood count (CBC)
• B. Activated partial thromboplastin time (aPTT)
• C. Serum electrolytes
• D. Liver function tests

Correct answer: B

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory test monitored to evaluate the effectiveness of anticoagulant therapy, particularly with heparin. It measures the time it takes for blood to clot, and monitoring aPTT helps ensure the therapeutic range is maintained to prevent clot formation and excessive bleeding. Choices A, C, and D are incorrect because a complete blood count (CBC) assesses overall health, serum electrolytes evaluate the body's electrolyte balance, and liver function tests assess liver health, none of which directly evaluate the effectiveness of anticoagulant therapy for DVT.

3. The client is reinforcing instructions for a low-sodium diet. Which statement by the client indicates a need for further teaching?

• A. I will avoid adding salt to my food while cooking.
• B. I will use salt substitutes instead of regular salt.
• C. I can eat as much processed food as I like since it's usually low in sodium.
• D. I will read food labels to check for sodium content.

Correct answer: C

Rationale: The correct answer is C. Processed foods often contain high amounts of sodium, so they should be limited or avoided on a low-sodium diet. Choosing processed foods can lead to increased sodium intake, counteracting the purpose of following a low-sodium diet. Option A shows an understanding of avoiding added salt, Option B suggests using alternatives to regular salt, and Option D indicates a willingness to check food labels for sodium content, all of which are appropriate for a low-sodium diet. Therefore, the client's statement about eating processed foods freely is incorrect and requires further teaching.

4. The healthcare provider is monitoring a client with left-sided heart failure. Which assessment finding indicates that the client's condition is worsening?

• A. Clear lung sounds
• B. Increased peripheral pulses
• C. Bibasilar crackles
• D. Improved activity tolerance

Correct answer: C

Rationale: Bibasilar crackles are abnormal lung sounds that indicate fluid accumulation in the lungs, a sign that left-sided heart failure is worsening. This finding suggests that the client's condition is deteriorating and requires prompt intervention to prevent further complications. Clear lung sounds (Choice A) are normal and would not indicate worsening heart failure. Increased peripheral pulses (Choice B) may be seen in conditions like anxiety or exercise, but not specifically in worsening left-sided heart failure. Improved activity tolerance (Choice D) would be a positive sign, not an indicator of worsening heart failure.

5. A client has a new prescription for verapamil. Which of the following instructions should the nurse include?

• A. Monitor your heart rate daily.
• B. Take the medication at bedtime.
• C. Avoid consuming grapefruit juice.
• D. Take the medication with food.

Correct answer: A

Rationale: The correct answer is to instruct the client to monitor their heart rate daily when taking verapamil. Verapamil is a calcium channel blocker that can cause bradycardia, making it crucial to monitor the heart rate regularly to detect any changes promptly. Choice B, taking the medication at bedtime, is not specifically related to verapamil administration. Choice C, avoiding grapefruit juice, is more relevant to medications metabolized by CYP3A4 enzymes, not verapamil. Choice D, taking the medication with food, is not a specific instruction for verapamil, as it can be taken with or without food.

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