Nursing Elites

1. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which instruction should the nurse give to the client regarding lifestyle changes?

• A. Avoid prolonged sitting or standing.
• B. Use an electric razor to prevent cuts.
• C. Take your medication with a full glass of water.
• D. Eat a diet low in protein.

Correct answer: B

Rationale: The correct answer is B. Using an electric razor is advised to prevent cuts, which is crucial for individuals taking warfarin due to the increased risk of bleeding associated with this medication. Lifestyle changes related to warfarin therapy focus on minimizing the risk of bleeding, and using safety measures such as an electric razor is a practical recommendation to reduce the likelihood of injury. Choices A, C, and D are incorrect. Avoiding prolonged sitting or standing is more related to preventing blood clots than to the bleeding risk of warfarin. Taking warfarin with a full glass of water is not a specific lifestyle change associated with its use. Eating a diet low in protein is not a typical recommendation for individuals on warfarin therapy.

2. A client with chronic obstructive pulmonary disease (COPD) is prescribed theophylline. Which adverse effect should the nurse monitor for that indicates toxicity?

• A. Tachycardia
• B. Constipation
• C. Drowsiness
• D. Tremors

Correct answer: A

Rationale: The correct answer is A: Tachycardia. Tachycardia is a common sign of theophylline toxicity. The nurse should monitor the client for an increased heart rate, as it can indicate a dangerous level of theophylline in the body. Prompt medical attention is required if tachycardia is observed to prevent further complications. Choices B, C, and D are incorrect because constipation, drowsiness, and tremors are not typically associated with theophylline toxicity. While theophylline can cause gastrointestinal upset or central nervous system effects, tachycardia is a more specific and serious indicator of toxicity that requires immediate attention.

3. A client with a diagnosis of heart failure is receiving digoxin (Lanoxin) and furosemide (Lasix). The LPN/LVN should closely monitor the client for which potential complication?

• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hyponatremia

Correct answer: B

Rationale: The correct answer is B: Hypokalemia. Furosemide is a loop diuretic that promotes the loss of potassium in the urine, potentially leading to hypokalemia. Hypokalemia increases the risk of digoxin toxicity, as digoxin's effects can be potentiated in the presence of low potassium levels. Monitoring for hypokalemia is crucial to prevent adverse effects and maintain the therapeutic effectiveness of digoxin in clients with heart failure. Choices A, C, and D are incorrect because furosemide does not typically cause hyperkalemia, hypernatremia, or hyponatremia. Instead, it commonly leads to hypokalemia due to increased potassium excretion.

4. A client has a new prescription for sertraline. Which of the following instructions should the nurse include?

• A. Take the medication in the morning.
• B. Avoid consuming grapefruit juice.
• C. Take the medication with a full glass of water.
• D. Monitor for signs of weight gain.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to 'Avoid consuming grapefruit juice.' Grapefruit juice can increase sertraline levels, leading to an elevated risk of side effects. Instructing the client to avoid grapefruit juice is crucial to prevent potential interactions that could impact the effectiveness and safety of the medication. The other options are not directly related to sertraline administration. Taking the medication in the morning may vary depending on individual preferences or the prescriber's directions. Taking the medication with a full glass of water is a general instruction for many medications and not specific to sertraline. Monitoring for signs of weight gain is important but not a direct instruction related to taking sertraline.

5. A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. What should the nurse do first?

• A. Call a code blue.
• B. Call the healthcare provider.
• C. Check the client's status and lead placement.
• D. Press the recorder button on the ECG console.

Correct answer: C

Rationale: The correct first action for the nurse to take is to check the client's status and lead placement. This step is crucial to ensure that the alarm is not triggered by a simple issue such as lead displacement. Calling a code blue (choice A) is premature without assessing the client first. Contacting the healthcare provider (choice B) can be done after ruling out basic causes for the alarm. Pressing the recorder button (choice D) is not as urgent as checking the client's status and lead placement in this scenario.

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