Nursing Elites

1. The nurse is caring for a client on warfarin with an INR of 1.8. What is the most appropriate action?

• A. Increase the dose of warfarin.
• B. Administer vitamin K.
• C. Hold the warfarin and notify the healthcare provider.
• D. Monitor the client’s INR closely.

Correct answer: D

Rationale: An INR of 1.8 is below the therapeutic range for a client on warfarin, indicating the need for monitoring closely to ensure that the INR levels reach the desired therapeutic range. Increasing the dose of warfarin (Choice A) without proper monitoring may lead to an increased risk of bleeding. Administering vitamin K (Choice B) is not typically recommended unless the client is experiencing major bleeding or requires rapid reversal of warfarin's effects. Holding the warfarin and notifying the healthcare provider (Choice C) may be necessary in certain situations, but the immediate action in this case should be to monitor the client's INR closely to guide further management.

2. What is a condition characterized by episodes of severe, acute shortness of breath, often occurring at night?

• A. Paroxysmal nocturnal dyspnea
• B. Sleep apnea
• C. Orthopnea
• D. Dyspnea

Correct answer: A

Rationale: Paroxysmal nocturnal dyspnea is the correct answer. It is characterized by sudden episodes of severe shortness of breath during sleep, often waking the individual. Choice B, Sleep apnea, involves pauses in breathing during sleep but does not usually present with acute shortness of breath. Choice C, Orthopnea, refers to shortness of breath that occurs when lying flat and is relieved by sitting up. Choice D, Dyspnea, is a general term for difficult or labored breathing and does not specifically describe acute episodes at night.

3. What condition is characterized by narrowed or blocked arteries in the legs or arms, leading to pain and mobility issues?

• A. Peripheral artery disease
• B. Atherosclerosis
• C. Raynaud's disease
• D. Varicose veins

Correct answer: A

Rationale: The correct answer is A: Peripheral artery disease (PAD). PAD is a condition where the arteries in the legs or arms become narrowed or blocked, leading to pain and mobility issues. Choice B, Atherosclerosis, refers to the buildup of fats, cholesterol, and other substances in and on the artery walls, not specifically the narrowing or blockage in the extremities. Choice C, Raynaud's disease, is characterized by reduced blood flow to the extremities, leading to coldness, numbness, and color changes in the skin, but it is not primarily about narrowed or blocked arteries. Choice D, Varicose veins, involves enlarged, twisted veins usually in the legs, but it is not related to narrowed or blocked arteries causing pain and mobility issues.

4. What procedure uses a catheter to open blocked coronary arteries and improve blood flow to the heart muscle?

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

Correct answer: A

Rationale: The correct answer is A, Angioplasty. Angioplasty is a procedure where a catheter is used to open blocked coronary arteries and may involve the insertion of a stent to improve blood flow to the heart muscle. Stent placement (B) is a related procedure but specifically refers to the insertion of a stent. Coronary artery bypass graft (CABG) (C) is a surgical procedure that uses blood vessels to bypass blocked coronary arteries. Valve replacement (D) is a different procedure that involves replacing a heart valve, not opening blocked coronary arteries.

5. The nurse is giving digoxin to a client. What is the most important parameter to check before administration?

• A. Heart rate
• B. Blood pressure
• C. Respiratory rate
• D. Oxygen saturation

Correct answer: A

Rationale: The correct answer is A: Heart rate. Before administering digoxin, it is crucial to check the client's heart rate because digoxin can cause bradycardia, an abnormally slow heart rate. Monitoring the heart rate is essential to prevent potential complications associated with digoxin therapy. Choices B, C, and D are less critical parameters to assess before administering digoxin. While blood pressure is also important to monitor during digoxin therapy, the most crucial parameter to check due to the medication's potential effect on heart rate is the heart rate itself.

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