Nursing Elites

1. A client with atrial fibrillation is receiving warfarin (Coumadin). The nurse should monitor which laboratory test to determine the effectiveness of the therapy?

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

Correct answer: A

Rationale: To monitor the effectiveness of warfarin therapy in a client with atrial fibrillation, the nurse should assess the Prothrombin time (PT) and international normalized ratio (INR) levels. These tests help determine the clotting ability of the blood and ensure that the client's anticoagulation levels are within the therapeutic range, reducing the risk of bleeding or clotting complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy. Complete blood count (CBC) (Choice C) provides information about the cellular components of blood but does not directly assess the effectiveness of warfarin therapy. Fibrinogen level (Choice D) is not typically used to monitor warfarin therapy; it reflects the level of fibrinogen in the blood, which is involved in the clotting process.

2. A client with hypertension is prescribed a thiazide diuretic. What instruction should the nurse reinforce to the client?

• A. Take the medication in the morning.
• B. Increase potassium intake in the diet.
• C. Weigh yourself daily.
• D. Limit fluid intake to 2 liters per day.

Correct answer: C

Rationale: The correct answer is to weigh oneself daily. This instruction is important as daily weights help monitor fluid loss and are crucial for detecting early signs of fluid imbalance when taking a diuretic. Weighing daily allows for timely adjustments in treatment and helps prevent complications associated with fluid imbalance. Choice A is not directly related to the client's need for monitoring fluid balance. Choice B, although important for some diuretics, is not specific to thiazide diuretics. Choice D is not appropriate as limiting fluid intake without proper monitoring can lead to dehydration, especially when taking diuretics.

3. The client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin. Which action should the nurse take next?

• A. Administer another dose of nitroglycerin.
• B. Notify the healthcare provider immediately.
• C. Have the client lie down and rest.
• D. Encourage the client to take deep breaths.

Correct answer: B

Rationale: When a client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin, it may indicate a myocardial infarction, also known as a heart attack. In this situation, the nurse should immediately notify the healthcare provider to ensure prompt evaluation and appropriate intervention. Delay in seeking medical attention for chest pain unrelieved by nitroglycerin can be life-threatening, as it might be a sign of a more serious cardiac event. Administering another dose of nitroglycerin (Choice A) without further evaluation can be risky, as the client's condition may require a different intervention. Having the client lie down and rest (Choice C) or encouraging deep breaths (Choice D) are not appropriate actions in this scenario where a more serious cardiac event needs to be ruled out.

4. The healthcare provider is monitoring a client with left-sided heart failure. Which assessment finding indicates that the client's condition is worsening?

• A. Clear lung sounds
• B. Increased peripheral pulses
• C. Bibasilar crackles
• D. Improved activity tolerance

Correct answer: C

Rationale: Bibasilar crackles are abnormal lung sounds that indicate fluid accumulation in the lungs, a sign that left-sided heart failure is worsening. This finding suggests that the client's condition is deteriorating and requires prompt intervention to prevent further complications. Clear lung sounds (Choice A) are normal and would not indicate worsening heart failure. Increased peripheral pulses (Choice B) may be seen in conditions like anxiety or exercise, but not specifically in worsening left-sided heart failure. Improved activity tolerance (Choice D) would be a positive sign, not an indicator of worsening heart failure.

5. 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.

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