Nursing Elites

1. The client is receiving anticoagulant therapy for atrial fibrillation. Which laboratory test should be monitored to determine the effectiveness of the therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: A

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of anticoagulant therapy in clients with atrial fibrillation. These tests help ensure that the client is within the therapeutic range and are commonly used to assess the clotting ability of the blood. Monitoring PT and INR levels allows healthcare providers to adjust anticoagulant dosages as needed to prevent complications such as bleeding or thrombosis. Activated partial thromboplastin time (aPTT) is more commonly used to monitor heparin therapy, not anticoagulant therapy for atrial fibrillation. Platelet count assesses the number of platelets in the blood and is not a direct indicator of anticoagulant therapy effectiveness. Erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and is not used to monitor anticoagulant therapy.

2. A client has a new prescription for atenolol. Which of the following instructions should be included?

• A. Take the medication with food.
• B. Monitor heart rate daily.
• C. Avoid eating foods high in potassium.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct answer is to monitor heart rate daily. Atenolol is a beta-blocker that can lead to bradycardia, a condition characterized by a slow heart rate. Monitoring the heart rate daily is essential to detect any abnormal changes promptly, allowing for timely medical intervention if necessary. Choice A is incorrect because atenolol can be taken with or without food. Choice C is irrelevant as atenolol does not interact with potassium-rich foods. Choice D is incorrect as atenolol is usually taken in the morning to help manage blood pressure throughout the day.

3. A client is scheduled for a coronary artery bypass graft (CABG) surgery. The nurse should prepare the client by reinforcing information about which post-operative care measure?

• A. You will be on bed rest for the first 48 hours after surgery.
• B. You will be encouraged to cough and deep breathe frequently.
• C. You will be discharged within 24 hours if no complications arise.
• D. You will not be able to eat or drink for 24 hours after surgery.

Correct answer: B

Rationale: Encouraging the client to cough and deep breathe frequently is essential post-operative care to prevent respiratory complications such as atelectasis and pneumonia after CABG surgery. Choices A, C, and D are incorrect because post-CABG surgery, early mobilization is encouraged to prevent complications such as deep vein thrombosis (DVT) and pneumonia. Discharge within 24 hours is unlikely after CABG surgery, and early oral intake is encouraged to promote recovery and prevent complications.

4. The nurse is preparing to care for a client who will be arriving from the recovery room after an above-the-knee amputation. The nurse ensures that which priority item is available for emergency use?

• A. Surgical tourniquet
• B. Dry sterile dressings
• C. Incentive spirometer
• D. Over-the-bed trapeze

Correct answer: A

Rationale: In the case of an above-the-knee amputation, the priority item that should be available for emergency use is a surgical tourniquet. This is crucial to control severe bleeding that may occur post-operatively. Dry sterile dressings (choice B) are important for wound care but not for immediate post-operative emergencies like bleeding. An incentive spirometer (choice C) is used for respiratory exercises and not directly related to emergency management post-amputation. An over-the-bed trapeze (choice D) is used for assisting clients with mobility and positioning, not for emergency situations involving bleeding.

5. The LPN/LVN is reinforcing discharge instructions to a client who has been prescribed nitroglycerin sublingual tablets for angina. Which statement by the client indicates a need for further teaching?

• A. I will keep my nitroglycerin tablets in the original glass bottle.
• B. I will sit or lie down when I take a nitroglycerin tablet.
• C. I will take a nitroglycerin tablet every 5 minutes if chest pain persists, up to a total of 3 tablets.
• D. I can swallow the nitroglycerin tablet with a glass of water if it does not dissolve quickly.

Correct answer: D

Rationale: The correct answer is D. Nitroglycerin sublingual tablets should not be swallowed; they must dissolve under the tongue to be effective. Choice A is correct as nitroglycerin tablets should be stored in their original glass container to prevent degradation. Choice B is correct as sitting or lying down when taking a nitroglycerin tablet helps prevent dizziness or fainting due to a sudden drop in blood pressure. Choice C is correct as taking a nitroglycerin tablet every 5 minutes for a maximum of 3 tablets is the correct protocol for managing angina symptoms.

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