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. The nurse supervises care of a client who is receiving enteral feeding via a nasogastric tube. The nurse determines that care is appropriate if which of the following is observed? (Select all that apply)

• A. The nursing assistant aspirates and measures the amount of the gastric aspirate
• B. The nursing assistant elevates the head of the client’s bed 30 degrees
• C. The nursing assistant warms the formula to room temperature
• D. B, C

Correct answer: D

Rationale: Elevating the head of the bed to 30 degrees reduces the risk of aspiration by promoting proper digestion and preventing reflux. Warming the formula to room temperature is essential to prevent discomfort and complications. Aspirating and measuring the gastric aspirate is not a recommended nursing action for monitoring enteral feeding via a nasogastric tube, as it can introduce the risk of introducing contaminants into the feeding tube. Therefore, choices A and B are incorrect, making choice D the correct answer.

3. The nurse is planning to provide education about foods containing thiamine to a group of clients. Which food high in thiamine should the nurse include?

• A. Fish
• B. Pork
• C. Beef
• D. Eggs

Correct answer: B

Rationale: The correct answer is B: Pork. Pork is high in thiamine, which is important for preventing thiamine deficiency. Thiamine, also known as vitamin B1, is essential for the proper functioning of the nervous system and metabolism. While fish, beef, and eggs are nutritious foods, they are not as high in thiamine as pork. Fish is more commonly known for its omega-3 fatty acids, beef for its iron content, and eggs for being a good source of protein and other nutrients.

4. A client is ordered lisinopril (Zestril) for the treatment of hypertension. He asks the nurse about possible adverse effects. The nurse should inform him about which common adverse effects of angiotensin-converting enzyme (ACE) inhibitors?

• A. Constipation
• B. Dizziness
• C. Headache
• D. B, C

Correct answer: D

Rationale: The correct answer is D: 'B, C.' Dizziness and headache are common side effects of ACE inhibitors due to their blood pressure-lowering effects. Constipation is not a common adverse effect associated with ACE inhibitors, so choice A is incorrect. Choice B (Dizziness) and choice C (Headache) are more commonly seen and are directly related to the mechanism of action of ACE inhibitors, making them the correct choices.

5. Where do most peptic ulcers occur?

• A. Esophagus
• B. Stomach
• C. Duodenum
• D. Jejunum

Correct answer: C

Rationale: Most peptic ulcers occur in the duodenum, particularly in cases of duodenal ulcers. The correct answer is the duodenum because it is the most common site for peptic ulcers to develop. Peptic ulcers rarely occur in the esophagus and jejunum, making choices A, B, and D incorrect.

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