Nursing Elites

1. The client is receiving heparin therapy for deep vein thrombosis (DVT). Which lab test should be monitored to evaluate the effectiveness of heparin?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Fibrinogen levels

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the appropriate lab test to monitor the therapeutic effectiveness of heparin therapy. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure the client is within the therapeutic range to prevent clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, a different anticoagulant that affects the extrinsic pathway of the coagulation cascade. Fibrinogen levels are not specific to monitoring heparin therapy.

2. The nurse is caring for a client receiving anticoagulant therapy. Which instruction should the nurse reinforce with the client to prevent bleeding complications?

• A. Use a soft-bristle toothbrush and electric razor.
• B. Increase your intake of vitamin K-rich foods.
• C. Take aspirin if you have a headache.
• D. Avoid using ice packs for injuries.

Correct answer: A

Rationale: The correct instruction to prevent bleeding complications in a client on anticoagulant therapy is to use a soft-bristle toothbrush and an electric razor. These implements help reduce the risk of bleeding by being gentle on the skin and reducing the chances of cuts or abrasions that could lead to bleeding in individuals on anticoagulants. Choice B is incorrect because increasing intake of vitamin K-rich foods can interfere with the action of anticoagulants. Choice C is incorrect as aspirin is a blood thinner and can increase the risk of bleeding when combined with anticoagulant therapy. Choice D is incorrect as ice packs can help reduce bleeding and swelling in injuries, but in a client on anticoagulant therapy, it is important to avoid potential trauma to the skin that could lead to bleeding.

3. The healthcare professional is reinforcing teaching for a client with peripheral artery disease (PAD). Which statement by the client indicates a need for further teaching?

• A. I will keep my legs elevated on pillows while resting.
• B. I will avoid crossing my legs when sitting.
• C. I will wear loose-fitting, comfortable shoes.
• D. I will avoid exposure to cold temperatures.

Correct answer: A

Rationale: The correct answer is A. Elevating the legs can decrease blood flow in clients with PAD, worsening symptoms. Therefore, advising the client to keep the legs elevated on pillows while resting is incorrect and can exacerbate the condition. Choice B is correct as avoiding crossing legs helps prevent circulation restriction. Choice C is correct as wearing loose-fitting shoes promotes circulation. Choice D is correct as avoiding exposure to cold temperatures helps prevent vasoconstriction, which can worsen PAD symptoms.

4. A client with a history of myocardial infarction (MI) is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse reinforce?

• A. Store the tablets in a cool, dry place away from light.
• B. Take a tablet every 5 minutes if chest pain occurs.
• C. Place the tablets under the tongue for sublingual absorption.
• D. Take the tablets without water for faster effect.

Correct answer: A

Rationale: The correct answer is A. Nitroglycerin tablets are light and moisture-sensitive, so they should be stored in a cool, dry place away from light to maintain their effectiveness. Option B advises taking a tablet every 5 minutes, which may lead to overdose as this frequency is too high. Option C emphasizes the correct administration route for sublingual tablets. Option D is incorrect as water is not needed for the tablets to take effect.

5. The nurse is preparing to administer an intravenous dose of potassium chloride to a client with hypokalemia. The nurse should monitor for which potential complication?

• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypercalcemia

Correct answer: A

Rationale: When administering potassium chloride to a client with hypokalemia, the nurse should monitor for hyperkalemia. Potassium chloride supplementation aims to increase potassium levels in individuals with hypokalemia. However, excessive administration can lead to hyperkalemia, which can be a serious and potentially life-threatening complication. Monitoring potassium levels is crucial to prevent this adverse outcome. Hypokalemia (Choice B) is the condition being treated, so it is not a complication of treatment. Hypernatremia (Choice C) refers to high sodium levels and is not directly related to the administration of potassium chloride. Hypercalcemia (Choice D) is an elevated calcium level and is not a common complication associated with potassium chloride administration in hypokalemia.

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