Nursing Elites

1. The client has atrial fibrillation and is receiving warfarin (Coumadin) therapy. Which laboratory test should be monitored to evaluate the effectiveness of the warfarin therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Complete blood count (CBC)
• D. Fibrinogen levels

Correct answer: A

Rationale: Monitoring the Prothrombin time (PT) and international normalized ratio (INR) is crucial for assessing the effectiveness of warfarin therapy. These tests help determine the clotting ability of the blood and ensure that the client is within the desired therapeutic range to prevent clotting events or bleeding complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy, not warfarin. Complete blood count (CBC) (Choice C) and fibrinogen levels (Choice D) do not directly assess the effectiveness of warfarin therapy in the same way that PT and INR do.

2. A client diagnosed with angina pectoris returns to the nursing unit after experiencing an angioplasty. The nurse reinforces instructions to the client regarding the procedure and home care measures. Which statement by the client indicates an understanding of the instructions?

• A. I am considering cutting my workload.
• B. I need to cut down on cigarette smoking.
• C. I am so relieved that my heart is repaired.
• D. I need to adhere to my dietary restrictions.

Correct answer: B

Rationale: The correct answer is B because cutting down on cigarette smoking is crucial for improving heart health after angioplasty. Smoking cessation helps in reducing the risk of complications and promotes better outcomes. Choices A and C are not directly related to post-angioplasty care. While reducing workload may be beneficial, it is not specifically related to the client's cardiac health. Feeling relieved that the heart is repaired is a positive emotional response but does not reflect understanding of the necessary measures. Adhering to dietary restrictions is important, but in this scenario, smoking cessation takes higher priority due to its immediate impact on heart health.

3. The client is receiving digoxin (Lanoxin) for heart failure. Which symptom would indicate digoxin toxicity?

• A. Increased appetite
• B. Yellow or blurred vision
• C. Increased urination
• D. Diarrhea

Correct answer: B

Rationale: Yellow or blurred vision can be a sign of digoxin toxicity. These visual disturbances are concerning as they indicate a potential adverse reaction to the medication. Recognizing this symptom promptly is crucial to prevent serious complications. Increased appetite, increased urination, and diarrhea are not typically associated with digoxin toxicity. Therefore, option B is the correct choice in this scenario.

4. While preparing a client for a cardiac catheterization, the client expresses a preference to speak with their doctor rather than the nurse. Which response by the nurse should be therapeutic?

• A. Your doctor expects me to prepare you for this procedure.
• B. That's fine, if that's what you want. I'll call your health care provider.
• C. So you're saying that you want to talk to your health care provider?
• D. I'm concerned with the way you've dismissed me. I know what I am doing.

Correct answer: C

Rationale: The therapeutic response by the nurse in this situation involves reflecting the client's feelings back to them, which demonstrates active listening and empathy. By restating the client's preference to talk to their doctor, the nurse acknowledges and validates the client's feelings, thereby fostering a positive therapeutic relationship and promoting open communication. Choices A and B do not acknowledge the client's preference and may come off as dismissive. Choice D is confrontational and defensive, which can lead to a breakdown in communication and trust between the nurse and the client.

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

• A. Monitor for a dry cough.
• 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 A: Monitor for a dry cough. When a client is prescribed enalapril, it is important to monitor for a dry cough because it can be a side effect that indicates a potential issue like angioedema. This side effect needs close attention as it may require discontinuation of the medication to prevent further complications. Choices B, C, and D are incorrect because enalapril does not need to be taken at bedtime, does not interact with grapefruit juice, and can be taken without regard to meals.

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