Nursing Elites

1. A client with a history of deep vein thrombosis (DVT) is prescribed warfarin (Coumadin). The nurse should include which instruction in the discharge teaching?

• A. Take the medication at the same time each day
• B. Avoid green leafy vegetables in your diet
• C. Increase your intake of vitamin K-rich foods
• D. Stop the medication if you notice any bruising

Correct answer: A

Rationale: Taking warfarin at the same time each day is crucial to maintain consistent blood levels and ensure the effectiveness of the medication in preventing clot formation. Consistent timing helps in monitoring and adjusting the dosage as needed to keep the international normalized ratio (INR) within the therapeutic range to prevent clotting events or excessive bleeding. Choices B, C, and D are incorrect. Avoiding green leafy vegetables is a misconception; while they are high in vitamin K which antagonizes warfarin, they should not be avoided but consumed in moderation. Increasing vitamin K-rich foods can interfere with warfarin's effectiveness. Stopping the medication due to bruising can be dangerous as it may indicate a clotting problem that the medication is intended to prevent.

2. A client who had a myocardial infarction (MI) two days ago reports chest pain radiating to the left arm. What should the nurse do immediately?

• A. Administer morphine
• B. Obtain an electrocardiogram (ECG)
• C. Apply oxygen via nasal cannula
• D. Administer sublingual nitroglycerin

Correct answer: B

Rationale: Obtaining an ECG is crucial in this situation because it helps in assessing for potential complications, such as a recurrent MI or ongoing ischemia. This diagnostic test provides valuable information to guide further interventions and treatment. Administering morphine, oxygen, or nitroglycerin may be necessary but obtaining an ECG takes precedence to evaluate the cardiac status and determine the appropriate course of action. Administering morphine without assessing the current cardiac status through an ECG can mask important diagnostic clues. Applying oxygen and administering nitroglycerin are supportive measures that can follow the ECG to address potential hypoxia and ischemic pain relief, respectively.

3. A healthcare provider is providing discharge teaching to a client who has a new prescription for furosemide. Which of the following statements should the provider include?

• A. Expect muscle pain.
• B. Monitor your weight daily.
• C. Avoid consuming grapefruit juice.
• D. Increase your intake of potassium-rich foods.

Correct answer: D

Rationale: When a client is prescribed furosemide, an important consideration is preventing hypokalemia, a potential side effect of the medication. Furosemide can lead to potassium depletion, so increasing the intake of potassium-rich foods is crucial to maintain adequate potassium levels in the body. Choices A, B, and C are incorrect because muscle pain is not a common side effect of furosemide, monitoring weight daily may not be directly related to the medication, and avoiding grapefruit juice is more relevant for certain medications that interact with grapefruit juice, not furosemide.

4. The LPN/LVN is assisting in the care of a client who has been prescribed enoxaparin (Lovenox) for the prevention of deep vein thrombosis (DVT). Which instruction should the nurse reinforce with the client?

• A. Avoid consuming foods high in vitamin K while taking this medication.
• B. Administer the injection in the same site each time for consistency.
• C. Report any unusual bleeding or bruising to your healthcare provider.
• D. Do not take aspirin if you experience any mild pain or discomfort.

Correct answer: C

Rationale: The correct instruction for the nurse to reinforce with the client is to report any unusual bleeding or bruising to their healthcare provider. This is crucial because unusual bleeding or bruising may indicate excessive anticoagulation, a potential side effect of enoxaparin. Prompt reporting to a healthcare provider is necessary to prevent complications. Choices A, B, and D are incorrect. Choice A is not directly related to enoxaparin and vitamin K interactions. Choice B is incorrect as rotating injection sites is essential for preventing tissue damage and irritation. Choice D is also incorrect as aspirin can increase the risk of bleeding when taken with enoxaparin.

5. The client is reinforcing teaching for peripheral artery disease (PAD). Which statement by the client indicates correct understanding?

• A. I will keep my legs elevated on pillows while resting.
• B. I will avoid crossing my legs when sitting.
• C. I will wear tight compression stockings to improve circulation.
• D. I will apply heat to my legs to relieve pain and improve circulation.

Correct answer: B

Rationale: The correct answer is B. Crossing the legs can further impede blood flow in clients with PAD, worsening symptoms. Avoiding leg crossing helps maintain adequate blood flow and reduces the risk of complications associated with peripheral artery disease. Choices A, C, and D are incorrect because elevating the legs, wearing tight compression stockings, and applying heat can exacerbate symptoms in PAD by restricting blood flow or causing potential harm.

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