Nursing Elites

1. The client diagnosed with acute vein thrombosis is receiving a continuous heparin drip, an intravenous anticoagulant. The health care provider orders warfarin (Coumadin), an oral anticoagulant. Which action should the nurse take?

• A. Discontinue the heparin drip before initiating the Coumadin
• B. Check the client’s INR before beginning Coumadin
• C. Clarify the order with the healthcare provider as soon as possible
• D. Administer the Coumadin along with the heparin drip as ordered

Correct answer: D

Rationale: The correct answer is to administer the Coumadin along with the heparin drip as ordered. Heparin and warfarin are often given together initially because warfarin takes a few days to become effective. Discontinuing the heparin drip before initiating Coumadin can increase the risk of clot formation. Checking the client's INR before starting Coumadin is important but not the immediate action required. Clarifying the order with the healthcare provider is not necessary as both medications are commonly used together.

2. Which electrolyte imbalance is a potential side effect of diuretics?

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

Correct answer: D

Rationale: The correct answer is D, Hypokalemia. Diuretics commonly lead to hypokalemia, which is low potassium levels in the body. Hyperkalemia (choice A) is the opposite, indicating high potassium levels. Hypercalcemia (choice B) refers to elevated calcium levels, not typically associated with diuretics. Hypomagnesemia (choice C) is low magnesium levels and can also be a consequence of diuretic use, but potassium imbalance is more common.

3. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?

• A. Notify the healthcare provider
• B. Document that the pericarditis has resolved
• C. Ask the client to lean forward and listen again
• D. Prepare to insert a unilateral chest tube

Correct answer: C

Rationale: The correct action for the nurse to implement when unable to auscultate a pericardial friction rub in a client diagnosed with pericarditis is to ask the client to lean forward and listen again. Leaning forward can help bring the heart closer to the chest wall, making it easier to detect the rub. Option A (Notifying the healthcare provider) is incorrect because further assessment is needed before escalating the situation. Option B (Documenting that the pericarditis has resolved) is incorrect as the absence of a friction rub does not necessarily mean resolution. Option D (Preparing to insert a unilateral chest tube) is incorrect as this intervention is not indicated for the absence of a friction rub.

4. Which question should the healthcare provider ask when assessing the client for an endocrine dysfunction?

• A. “Have you noticed any pain in your legs when walking?”
• B. “Have you had any unexplained weight loss?”
• C. “Have you noticed any change in your bowel movements?”
• D. “Have you experienced any joint pain or discomfort?”

Correct answer: B

Rationale: The correct answer is B: “Have you had any unexplained weight loss?” Unexplained weight loss can be a significant symptom of various endocrine disorders, such as hyperthyroidism and diabetes. Weight changes are often closely linked to endocrine dysfunction due to the hormonal imbalances affecting metabolism. Choices A, C, and D are less specific to endocrine dysfunction. Pain in the legs, changes in bowel movements, and joint pain or discomfort are symptoms that can be related to various health conditions but are not as indicative of endocrine disorders as unexplained weight loss.

5. Which of the following is NOT one of the major duties of the M6 practical nurse?

• A. Performing preventive, therapeutic, and emergency nursing care procedures
• B. Managing other paraprofessional personnel
• C. Managing ward or unit operations
• D. Implementing Level II through Level IV CSH operations

Correct answer: D

Rationale: The correct answer is D because implementing Level II through Level IV CSH operations is not a major duty of the M6 practical nurse. A practical nurse's major duties include performing preventive, therapeutic, and emergency nursing care procedures (Choice A), managing other paraprofessional personnel (Choice B), and managing ward or unit operations (Choice C). These duties are more aligned with the responsibilities of a practical nurse, emphasizing patient care and coordination within a healthcare setting.

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