Nursing Elites

1. A client is prescribed warfarin (Coumadin) for atrial fibrillation. Which dietary instruction should the nurse provide?

• A. Increase intake of green leafy vegetables
• B. Avoid foods high in vitamin K
• C. Increase intake of foods rich in vitamin C
• D. Limit intake of dairy products

Correct answer: B

Rationale: The correct answer is B: 'Avoid foods high in vitamin K.' Vitamin K can decrease the effectiveness of warfarin, so it is essential for clients on warfarin therapy to avoid foods high in vitamin K. Green leafy vegetables are high in vitamin K, so choice A is incorrect. Choices C and D are unrelated to the dietary restrictions needed for clients taking warfarin and are therefore incorrect.

2. The nurse plans to administer the rubella vaccine to a postpartum client whose titer is < 1:8 and who is breastfeeding. What information should the nurse provide this client?

• A. The client should bottle feed and pump her breast for 3 days following immunization
• B. The vaccine is given to produce maternal antibodies before lactation occurs
• C. The infant will receive immunization through the mother's breast milk
• D. The client should not get pregnant for 3 months after immunization

Correct answer: D

Rationale: Educating about the waiting period helps prevent possible rubella infection in a subsequent early pregnancy.

3. What is the most important information for the nurse to provide to a client with a diagnosis of major depressive disorder who is started on a selective serotonin reuptake inhibitor (SSRI)?

• A. Take the medication with food
• B. Avoid foods high in tyramine
• C. Report any thoughts of self-harm immediately
• D. Expect to see improvement within 24 hours

Correct answer: C

Rationale: The correct answer is C: 'Report any thoughts of self-harm immediately.' When starting an SSRI, clients should be informed to report any thoughts of self-harm promptly. SSRIs can initially increase suicidal ideation, especially in the early stages of treatment. This information is crucial for the client's safety and well-being. Choices A, B, and D are incorrect because taking the medication with food, avoiding foods high in tyramine, and expecting immediate improvement within 24 hours are not the most critical pieces of information for a client starting on an SSRI.

4. The nurse observes a client with new-onset tachycardia. What should the nurse do first?

• A. Check for the client's temperature
• B. Administer prescribed beta-blockers
• C. Assess for any chest pain or discomfort
• D. Monitor the client's blood pressure

Correct answer: C

Rationale: When a client presents with new-onset tachycardia, the first action the nurse should take is to assess for any associated symptoms like chest pain or discomfort. This is important to differentiate the potential causes of tachycardia and guide appropriate interventions. Checking the client's temperature (Choice A) may be relevant in certain situations but is not the priority when tachycardia is observed. Administering prescribed beta-blockers (Choice B) should only be done after a comprehensive assessment and healthcare provider's orders. Monitoring the client's blood pressure (Choice D) is important, but assessing for chest pain or discomfort takes precedence in this scenario to rule out cardiac causes of tachycardia.

5. A client with a diagnosis of bipolar disorder is taking lithium. What is the most important information the nurse should provide?

• A. Take the medication on an empty stomach
• B. Monitor sodium intake
• C. Report any signs of weight gain
• D. Avoid excessive caffeine intake

Correct answer: B

Rationale: The correct answer is B. Sodium levels can affect lithium levels in the body, so it is crucial to monitor sodium intake to prevent toxicity or subtherapeutic levels. Lithium is typically taken on an empty stomach to enhance absorption, making choice A more accurate than the original 'Take the medication with food.' Reporting weight gain, as mentioned in choice C, is important for monitoring side effects but is not as critical as ensuring proper lithium levels through sodium intake monitoring. Choice D, avoiding excessive caffeine intake, is not a priority concern directly related to lithium therapy.

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