Nursing Elites

1. A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse should reinforce which dietary instruction?

• A. Avoid foods high in vitamin K.
• B. Increase intake of dairy products.
• C. Limit intake of foods high in fiber.
• D. Increase protein intake.

Correct answer: A

Rationale: The correct answer is to avoid foods high in vitamin K. Clients taking warfarin (Coumadin) should maintain a consistent intake of vitamin K to keep the medication's effectiveness stable. Foods high in vitamin K, such as leafy greens, can interfere with the anticoagulant effects of warfarin. Therefore, it is crucial for clients to avoid these foods to ensure the therapeutic effects of warfarin. Choices B, C, and D are incorrect because increasing dairy products, limiting fiber intake, or increasing protein intake do not directly impact the effectiveness of warfarin therapy and are not necessary dietary modifications for clients on this medication.

2. The client with a history of left-sided heart failure is exhibiting increasing shortness of breath and frothy sputum. What is the priority nursing action?

• A. Administer oxygen
• B. Encourage coughing and deep breathing
• C. Place the client in a supine position
• D. Notify the healthcare provider immediately

Correct answer: A

Rationale: Shortness of breath and frothy sputum are indicative of pulmonary edema, a serious condition that requires immediate intervention to improve oxygenation. Administering oxygen is the priority action to support the client's respiratory function and prevent further deterioration. Oxygen therapy helps increase the oxygen levels in the blood, alleviate respiratory distress, and support vital organ function. Prompt intervention with oxygen can help stabilize the client while further assessments and treatments are initiated. Encouraging coughing and deep breathing may worsen the client's condition by increasing respiratory effort. Placing the client in a supine position can further compromise breathing in a client with pulmonary edema. Notifying the healthcare provider is important but not the priority when the client's respiratory status is deteriorating.

3. A client receives discharge teaching for a new prescription of lithium. Which instruction should be included?

• A. Take the medication with food.
• B. Increase your intake of sodium.
• C. Monitor for signs of hypercalcemia.
• D. Avoid consuming dairy products.

Correct answer: B

Rationale: The correct instruction to include when a client receives discharge teaching for a new prescription of lithium is to increase their intake of sodium. Lithium can lead to decreased sodium levels, putting the individual at risk of developing hyponatremia. By increasing sodium intake, the client can counteract this risk, maintain a proper sodium balance, and prevent complications. Choices A, C, and D are incorrect because taking lithium with food, monitoring for signs of hypercalcemia, and avoiding dairy products are not directly related to managing the side effects or risks associated with lithium therapy.

4. A client has a new prescription for prednisone. Which of the following statements should the nurse include in the teaching?

• A. You may experience weight gain.
• B. Increase your intake of vitamin K.
• C. Expect increased urinary output.
• D. You may have dark, tarry stools.

Correct answer: A

Rationale: The correct answer is A: 'You may experience weight gain.' Prednisone commonly causes weight gain as a side effect, so it is important for the client to be aware of this potential outcome. Monitoring weight changes can be essential in managing the medication's effects and overall health. Choices B, C, and D are incorrect. Increasing vitamin K intake is not specifically related to prednisone use. Expecting increased urinary output is not a common side effect of prednisone. Dark, tarry stools are more commonly associated with gastrointestinal bleeding rather than prednisone use.

5. An ambulatory clinic nurse is interviewing a client who is complaining of flu-like symptoms. The client suddenly develops chest pain. Which question best assists the nurse in discriminating pain caused by a non-cardiac problem?

• A. Can you describe the pain to me?
• B. Have you ever experienced this pain before?
• C. Does the pain get worse when you breathe in?
• D. Can you rate the pain on a scale of 1 to 10, with 10 being the worst?

Correct answer: C

Rationale: The correct answer is C. Pain that worsens with breathing in can indicate pleuritic chest pain, which is non-cardiac in nature. This specific question helps in differentiating non-cardiac causes from cardiac causes of chest pain, as cardiac pain typically does not worsen with breathing. Choices A, B, and D are less specific in discriminating between cardiac and non-cardiac chest pain.

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