Nursing Elites

1. 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.

2. The client is on amiodarone. What is the most important side effect to monitor for?

• A. Pulmonary toxicity
• B. Thyroid dysfunction
• C. Liver toxicity
• D. Renal dysfunction

Correct answer: A

Rationale: The correct answer is A: Pulmonary toxicity. Amiodarone is known for causing serious pulmonary toxicity, which can be fatal. Monitoring for pulmonary toxicity is crucial due to its potential severity. Choice B, thyroid dysfunction, is a common side effect of amiodarone but is not as immediately life-threatening as pulmonary toxicity. Choices C and D, liver toxicity and renal dysfunction, are potential side effects of amiodarone but are not as critical or as common as pulmonary toxicity, making them less important to monitor initially.

3. 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.

4. What test measures the electrical activity of the heart to detect arrhythmias and other heart conditions?

• A. Electrocardiogram (ECG or EKG)
• B. Chest X-ray
• C. Stress test
• D. Arterial blood gas (ABG)

Correct answer: A

Rationale: An electrocardiogram (ECG or EKG) is used to measure the heart's electrical activity, aiding in the detection of arrhythmias and other heart conditions. Choice B, a chest X-ray, is not used to measure electrical activity but to visualize the structures of the chest. Choice C, a stress test, evaluates the heart's response to exertion and is not primarily focused on measuring electrical activity. Choice D, an arterial blood gas (ABG) test, is used to assess oxygen and carbon dioxide levels in the blood, not the heart's electrical activity.

5. This is a chronic condition where the heart is unable to pump enough blood to meet the body's needs.

• A. Heart failure
• B. Cardiomyopathy
• C. Myocarditis
• D. Pericarditis

Correct answer: A

Rationale: The correct answer is A: Heart failure. Heart failure is a chronic condition characterized by the heart's inability to pump enough blood to meet the body's needs, resulting in symptoms such as fatigue, shortness of breath, and fluid retention. Choice B, Cardiomyopathy, refers to diseases of the heart muscle that can lead to heart failure but is not the specific term for the condition described. Choices C and D, Myocarditis and Pericarditis, respectively, are conditions involving inflammation of the heart muscle or the lining around the heart, which can cause heart failure as a complication but are not the primary condition described in the question.

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