Nursing Elites

1. What is the primary purpose of administering anticoagulants to a patient with atrial fibrillation?

• A. To reduce blood pressure.
• B. To prevent clot formation.
• C. To prevent arrhythmias.
• D. To reduce inflammation.

Correct answer: B

Rationale: The primary purpose of administering anticoagulants to a patient with atrial fibrillation is to prevent clot formation. Patients with atrial fibrillation are at an increased risk of forming blood clots in the heart, which can lead to stroke if they travel to the brain. Anticoagulants help to reduce this risk by inhibiting the clotting process. Therefore, choices A, C, and D are incorrect because anticoagulants do not primarily aim to reduce blood pressure, prevent arrhythmias, or reduce inflammation in patients with atrial fibrillation.

2. A healthcare professional assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?

• A. A 36-year-old female who has never been pregnant
• B. A 42-year-old male who is prescribed cyclophosphamide
• C. A 58-year-old female who is not taking estrogen replacement
• D. A 77-year-old male with mild congestive heart failure

Correct answer: C

Rationale: Females are at higher risk of developing bacterial cystitis due to their shorter urethra compared to males. Postmenopausal women not on estrogen replacement therapy are particularly susceptible to cystitis because of changes in vaginal and urethral cells. This increases the risk of bacterial infection. The other options do not have the same level of risk as the postmenopausal woman not using hormone replacement therapy. A never-pregnant middle-aged woman does not have the same increased risk as a postmenopausal woman with hormonal changes.

3. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient’s face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?

• A. Request an order for IV epinephrine to treat anaphylactic shock.
• B. Slow the infusion to 10 mg/min and observe the patient closely.
• C. Stop the infusion and obtain an order for a BUN and serum creatinine.
• D. Suspect Stevens-Johnson syndrome and notify the provider immediately.

Correct answer: B

Rationale: When vancomycin is infused too rapidly, “red man” syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

4. What do crackles heard on lung auscultation indicate?

• A. Cyanosis.
• B. Bronchospasm.
• C. Airway narrowing.
• D. Fluid-filled alveoli.

Correct answer: D

Rationale: Crackles heard on lung auscultation are caused by the popping open of small airways that are filled with fluid. This is commonly associated with conditions such as pulmonary edema, pneumonia, or heart failure. Cyanosis (Choice A) is a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood, not directly related to crackles. Bronchospasm (Choice B) refers to the constriction of the airway smooth muscle, causing difficulty in breathing but does not typically produce crackles. Airway narrowing (Choice C) can lead to wheezing but is not directly linked to crackles heard on auscultation.

5. The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotensin-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)?

• A. A complete blood count
• B. BUN and creatinine
• C. Electrolytes
• D. Glucose

Correct answer: C

Rationale: The correct answer is 'C. Electrolytes.' When trimethoprim-sulfamethoxazole (TMP-SMX) is taken with an ACE inhibitor, there is an increased risk of hyperkalemia due to the combined effects on potassium levels. Monitoring electrolytes, specifically potassium, is essential to detect and manage this potential drug interaction. Choices A, B, and D are incorrect because while they are important tests in general patient care, they are not specifically indicated to monitor for the drug interaction between TMP-SMX and ACE inhibitors.

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