Nursing Elites

1. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should the nurse monitor to determine the effectiveness of the medication?

• A. Platelet count.
• B. Prothrombin time (PT) and international normalized ratio (INR).
• C. Activated partial thromboplastin time (aPTT).
• D. Fibrinogen level.

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of warfarin (Coumadin) therapy. These tests help assess the clotting time and the desired anticoagulant effect of the medication. Monitoring PT and INR levels is crucial to ensure that the client is within the therapeutic range, reducing the risk of bleeding or clotting complications associated with warfarin therapy. Platelet count (Choice A) measures the number of platelets in the blood and is not specific for monitoring warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice C) is more commonly used to monitor heparin therapy, not warfarin. Fibrinogen level (Choice D) assesses the amount of fibrinogen in the blood and is not a specific test for monitoring warfarin therapy.

2. When assessing a male client who is receiving a unit of packed red blood cells (PRBCs), the nurse notes that the infusion was started 30 minutes ago, and 50 ml of blood is left to be infused. The client's vital signs are within normal limits. He reports feeling 'out of breath' but denies any other complaints. What action should the nurse take at this time?

• A. Administer a PRN prescription for diphenhydramine (Benadryl).
• B. Start the normal saline attached to the Y-tubing at the same rate.
• C. Decrease the intravenous flow rate of the PRBC transfusion.
• D. Ask the respiratory therapist to administer PRN albuterol (Ventolin).

Correct answer: C

Rationale: In this scenario, the client is experiencing symptoms of shortness of breath, which could indicate fluid overload from the PRBC transfusion. By decreasing the intravenous flow rate of the transfusion, the nurse can slow down the rate of blood being infused, potentially alleviating the symptoms of fluid overload and shortness of breath. This intervention can help prevent further complications and promote the client's comfort and safety.

3. A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

• A. Two to three soft bowel movements daily
• B. Significant increase in appetite and food intake
• C. Absence of nausea and vomiting
• D. Absence of blood or mucus in stool

Correct answer: A

Rationale: Lactulose is used in hepatic encephalopathy to reduce blood ammonia levels by promoting bowel movements. The desired outcome of lactulose therapy is typically two to three soft bowel movements daily, which helps in eliminating excess ammonia from the body, thus improving the client's condition.

4. Following a CVA, the nurse assesses that a client has developed dysphagia, hypoactive bowel sounds, and a firm, distended abdomen. Which prescription for the client should the nurse question?

• A. Continuous tube feeding at 65 ml/hr via gastrostomy.
• B. Total parenteral nutrition to be infused at 125 ml/hour.
• C. Nasogastric tube connected to low intermittent suction.
• D. Metoclopramide (Reglan) intermittent piggyback.

Correct answer: A

Rationale: In a client with dysphagia and gastrointestinal symptoms such as hypoactive bowel sounds and a firm, distended abdomen, continuous tube feeding might exacerbate the symptoms. This can lead to complications and should be questioned by the nurse.

5. A 56-year-old woman presents to discuss the results of her recent upper endoscopy. She was having some mild abdominal pain, so she underwent the procedure, which revealed an ulcer in the antrum of the stomach. Biopsy of the lesion revealed the presence of H. pylori. All of the following statements regarding her condition are correct except

• A. H. pylori has been associated with gastric MALT (mucosa-associated lymphoid tissue)
• B. Reinfection is rare despite adequate treatment
• C. Triple drug therapy has been shown to be more effective than dual drug therapy
• D. If her H. pylori IgG antibody titer was elevated prior to therapy, it can be used to monitor treatment efficacy

Correct answer: B

Rationale: H. pylori is associated with a majority of peptic ulcer disease cases and has links to gastric MALT and adenocarcinoma. Triple drug therapy is more effective than dual therapy. Reinfection after adequate treatment is rare. While urea breath testing is a better diagnostic tool, quantitative serology can monitor treatment efficacy. A 30% decrease in IgG titer should occur post-therapy, indicating effectiveness.

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