Nursing Elites

1. Which laboratory test should the nurse monitor to determine the effectiveness of heparin therapy for a client with deep vein thrombosis?

• A. Platelet count
• B. Prothrombin time (PT)
• C. Activated partial thromboplastin time (aPTT)
• D. Hemoglobin and hematocrit

Correct answer: C

Rationale: The activated partial thromboplastin time (aPTT) is the specific laboratory test used to monitor the effectiveness of heparin therapy in patients with deep vein thrombosis. It measures the time it takes for blood to clot and is crucial in assessing the therapeutic range of heparin. Platelet count, prothrombin time (PT), and hemoglobin and hematocrit levels are important parameters in assessing coagulation and blood status but do not directly indicate the effectiveness of heparin therapy.

2. A client is receiving intravenous gentamicin (Garamycin). Which of the following findings should prompt the nurse to notify the healthcare provider immediately?

• A. Nausea
• B. Hearing loss
• C. Headache
• D. Diarrhea

Correct answer: B

Rationale: Gentamicin (Garamycin) is an aminoglycoside antibiotic known to cause ototoxicity, which can manifest as hearing loss. Hearing loss is a serious adverse effect that should be reported promptly to the healthcare provider to prevent further complications or adjust the treatment regimen. Nausea, headache, and diarrhea are common side effects of gentamicin but are not as severe or urgent as hearing loss in this context.

3. A client with hyperlipidemia is prescribed simvastatin (Zocor). Which instruction should the nurse include in the teaching plan?

• A. Take the medication in the evening.
• B. Report any muscle pain to your healthcare provider.
• C. Avoid increasing your intake of grapefruit juice.
• D. Do not take the medication with a high-fat meal.

Correct answer: B

Rationale: Muscle pain can be a sign of a serious side effect of simvastatin (Zocor) known as rhabdomyolysis and should be reported to the healthcare provider immediately. The medication is usually taken in the evening to coincide with the body's natural production of cholesterol. Grapefruit juice should be avoided as it can increase the risk of toxicity by affecting the metabolism of the medication. Additionally, taking simvastatin with a high-fat meal can reduce its effectiveness, so it should be taken without food or with a light meal.

4. A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will:

• A. Drink at least 2 L of fluid per day.
• B. Take the daily dose at bedtime.
• C. Avoid changing brands of the medication without health care provider (HCP) approval.
• D. Avoid over-the-counter (OTC) cough and cold medications unless approved by the HCP.

Correct answer: B

Rationale: The correct answer is B. Taking theophylline at bedtime is inappropriate because it can cause insomnia. The medication should be taken early in the morning to avoid disrupting sleep patterns. It is important to follow the healthcare provider's instructions regarding the timing of the medication to achieve optimal therapeutic effects.

5. Before initiating a client with tuberculosis on anti-tuberculosis therapy with isoniazid (INH), a nurse ensures that which of the following baseline study has been completed?

• A. Electrolyte levels
• B. Coagulation times
• C. Liver enzyme levels
• D. Serum creatinine level

Correct answer: C

Rationale: Before starting INH therapy for tuberculosis, it is essential to assess liver enzyme levels as INH can cause hepatotoxicity. Monitoring liver enzyme levels before and during the initial 3 months of therapy is crucial to detect any liver damage early and prevent further complications. Choice A, electrolyte levels, are not directly impacted by INH therapy. Choice B, coagulation times, are not routinely monitored before starting INH therapy. Choice D, serum creatinine level, is not specifically required as a baseline study before initiating INH therapy for tuberculosis.

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