Nursing Elites

1. A client with deep vein thrombosis has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

• A. Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.
• B. I will call the provider to get a prescription for discontinuing the IV heparin today.
• C. Both heparin and warfarin work together to dissolve the clots.
• D. The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay.

Correct answer: A

Rationale: The correct answer is A because warfarin takes several days to reach a therapeutic level and exert its full anticoagulant effect. During this time, the IV heparin is continued to prevent clotting until the warfarin is effective. Both medications are used together temporarily for this reason. Discontinuing heparin prematurely can increase the risk of clot formation. Therefore, the nurse should explain to the client that the IV heparin will be continued until the warfarin reaches a therapeutic level.

2. A healthcare provider is caring for several clients who came to the clinic for a seasonal influenza immunization. The provider should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection?

• A. 1-year-old who has no health problems
• B. 17-year-old who has a hypersensitivity to Penicillin
• C. 25-year-old who is pregnant
• D. 52-year-old who takes a multivitamin supplement

Correct answer: B

Rationale: The correct answer is B. A 17-year-old can receive the influenza vaccine via nasal spray even if they have a hypersensitivity to penicillin, as this is not a contraindication for the influenza immunization. The nasal spray vaccine (LAIV) is a live attenuated vaccine that is suitable for healthy individuals aged 2-49 years. Pregnancy (choice C) is a contraindication for the nasal spray influenza vaccine. Children under 2 years of age (choice A) are also not candidates for the nasal spray. Taking a multivitamin supplement (choice D) is not a determining factor for the type of influenza vaccine a person should receive.

3. When teaching a client with a new prescription for Amiodarone, which instruction should the nurse include?

• A. Take this medication with meals.
• B. Avoid drinking grapefruit juice.
• C. Take this medication at bedtime.
• D. Increase your intake of sodium-rich foods.

Correct answer: B

Rationale: The correct instruction is to avoid drinking grapefruit juice when taking Amiodarone. Grapefruit juice can inhibit the metabolism of Amiodarone, leading to increased blood levels of the drug and potentially causing adverse effects like cardiac toxicity. Choices A, C, and D are incorrect because taking Amiodarone with meals, at bedtime, or increasing sodium-rich foods intake are not relevant instructions for this medication.

4. A client with a history of migraine headaches is starting prophylaxis therapy with Propranolol. Which of the following findings in the client history should be reported to the provider by the nurse?

• A. The client had a prior myocardial infarction.
• B. The client takes warfarin for atrial fibrillation.
• C. The client takes an SSRI for depression.
• D. An ECG indicates a first-degree heart block.

Correct answer: D

Rationale: Propranolol is contraindicated in clients with a first-degree heart block due to its negative chronotropic properties that can further slow the heart rate. This can worsen conduction through the atrioventricular node, potentially leading to heart block progression. Therefore, the nurse should report the finding of a first-degree heart block to the provider before initiating Propranolol therapy. Choices A, B, and C are not contraindications for Propranolol therapy. A prior myocardial infarction, taking warfarin for atrial fibrillation, or using an SSRI for depression do not directly impact the initiation of Propranolol therapy in a client with a history of migraine headaches.

5. Which adverse reaction poses the greatest life-threatening risk when taking Omeprazole?

• A. Chest pain
• B. Constipation
• C. Clostridium difficile-associated diarrhea
• D. Acute interstitial nephritis

Correct answer: C

Rationale: The most life-threatening adverse reaction associated with Omeprazole is Clostridium difficile-associated diarrhea. This condition can be severe and life-threatening due to the potential for dehydration, electrolyte imbalances, and complications such as toxic megacolon. Chest pain, constipation, and acute interstitial nephritis are potential side effects of Omeprazole but are not considered as life-threatening as Clostridium difficile-associated diarrhea. Monitoring for signs of this adverse reaction is crucial, and immediate medical attention should be sought if symptoms develop.

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