Nursing Elites

1. The healthcare provider is teaching a client about the use of nitroglycerin patches for angina pectoris. Which instruction should the healthcare provider include?

• A. Apply the patch to the same site each day
• B. Remove the patch at bedtime to prevent tolerance
• C. Cover the patch with a bandage to keep it in place
• D. Rotate the application site every 24 hours

Correct answer: D

Rationale: Rotating the application site every 24 hours is crucial when using nitroglycerin patches to prevent skin irritation and ensure consistent absorption of the medication. By rotating the site, the risk of local skin reactions is reduced, and the effectiveness of the nitroglycerin patch is maintained. Applying the patch to the same site each day (Choice A) can lead to skin irritation. Removing the patch at bedtime (Choice B) is not necessary as long as the prescribed wearing schedule is followed. Covering the patch with a bandage (Choice C) is not recommended as it may interfere with proper absorption.

2. The LPN/LVN is assisting in the care of a client who has been prescribed enoxaparin (Lovenox) for the prevention of deep vein thrombosis (DVT). Which instruction should the nurse reinforce with the client?

• A. Avoid consuming foods high in vitamin K while taking this medication.
• B. Administer the injection in the same site each time for consistency.
• C. Report any unusual bleeding or bruising to your healthcare provider.
• D. Do not take aspirin if you experience any mild pain or discomfort.

Correct answer: C

Rationale: The correct instruction for the nurse to reinforce with the client is to report any unusual bleeding or bruising to their healthcare provider. This is crucial because unusual bleeding or bruising may indicate excessive anticoagulation, a potential side effect of enoxaparin. Prompt reporting to a healthcare provider is necessary to prevent complications. Choices A, B, and D are incorrect. Choice A is not directly related to enoxaparin and vitamin K interactions. Choice B is incorrect as rotating injection sites is essential for preventing tissue damage and irritation. Choice D is also incorrect as aspirin can increase the risk of bleeding when taken with enoxaparin.

3. A client with chronic obstructive pulmonary disease (COPD) is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction should the nurse reinforce to ensure correct use?

• A. Inhale deeply and slowly after activating the MDI.
• B. Hold the breath for 5 seconds after inhaling the medication.
• C. Rinse the mouth immediately after using the MDI.
• D. Exhale fully before placing the mouthpiece in the mouth.

Correct answer: A

Rationale: Inhaling deeply and slowly after activating the MDI is the correct instruction to ensure effective delivery of the medication to the lungs. This technique helps the medication reach the lower airways where it can be most beneficial in managing COPD symptoms. Inhaling too quickly or not deeply enough may result in improper drug delivery and reduce the effectiveness of the treatment. Holding the breath for 5 seconds after inhaling the medication (Choice B) may not be necessary and could cause discomfort without additional benefits. Rinsing the mouth immediately after using the MDI (Choice C) is not necessary unless specified by the healthcare provider. Exhaling fully before placing the mouthpiece in the mouth (Choice D) is not ideal as it may result in inadequate medication delivery to the lungs.

4. A client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned, knowing that this level could lead to which complication?

• A. Stroke
• B. Cardiac arrest
• C. High blood pressure
• D. Urinary stone formation

Correct answer: B

Rationale: A serum calcium level below normal (hypocalcemia) can lead to cardiac arrhythmias and potentially cardiac arrest. Calcium plays a crucial role in cardiac muscle contractility, and low levels can disrupt normal heart function, potentially leading to fatal arrhythmias and cardiac arrest. Choices A, C, and D are incorrect as hypocalcemia is not directly associated with stroke, high blood pressure, or urinary stone formation. The immediate concern with low serum calcium levels is the risk of cardiac complications.

5. A client with atrial fibrillation is receiving warfarin (Coumadin). The nurse should monitor which laboratory test to determine the effectiveness of the therapy?

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

Correct answer: A

Rationale: To monitor the effectiveness of warfarin therapy in a client with atrial fibrillation, the nurse should assess the Prothrombin time (PT) and international normalized ratio (INR) levels. These tests help determine the clotting ability of the blood and ensure that the client's anticoagulation levels are within the therapeutic range, reducing the risk of bleeding or clotting complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy. Complete blood count (CBC) (Choice C) provides information about the cellular components of blood but does not directly assess the effectiveness of warfarin therapy. Fibrinogen level (Choice D) is not typically used to monitor warfarin therapy; it reflects the level of fibrinogen in the blood, which is involved in the clotting process.

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