a nurse is caring for a client who has deep vein thrombosis and is receiving heparin therapy which test should the nurse use to monitor and regulate t a nurse is caring for a client who has deep vein thrombosis and is receiving heparin therapy which test should the nurse use to monitor and regulate t
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Nursing Elites

ATI RN

ATI Exit Exam

1. A client with deep vein thrombosis receiving heparin therapy needs monitoring. Which test should the nurse use to regulate the medication dosage?

Correct answer: C

Rationale: The correct answer is C: Activated partial thromboplastin time (aPTT). aPTT is specifically used to monitor and regulate heparin therapy as it assesses the intrinsic pathway of coagulation, which heparin affects. Options A and B, Prothrombin time (PT) and International Normalized Ratio (INR), are used to monitor warfarin therapy, not heparin. Option D, Fibrinogen levels, is not the primary test used to monitor heparin therapy.

2. Which medical condition is characterized by symptoms such as oral candidiasis, hairy leukoplakia, herpetic ulcerations, Kaposi's sarcoma, xerostomia, and severe periodontal disease?

Correct answer: Acquired Immunodeficiency Syndrome (AIDS)

Rationale: Acquired Immunodeficiency Syndrome (AIDS) is known for a variety of oral manifestations such as oral candidiasis, hairy leukoplakia, herpetic ulcerations, Kaposi's sarcoma, xerostomia, and severe periodontal disease. These symptoms are not typically associated with acute leukemia, anorexia nervosa, or bulimia. Acute leukemia usually presents with symptoms like fatigue, frequent infections, and easy bruising. Anorexia nervosa and bulimia are eating disorders, thus their primary symptoms are primarily associated with eating habits and body weight, not oral health.

3. When a Tae Kwon Do (TKD) master applies downward pressure just above the elbow joint on an attacker who immediately collapses to the ground, which reflex is applicable to this example?

Correct answer: A

Rationale: The Golgi tendon reflex is the correct answer. This reflex protects the muscle and tendons from excessive force by causing the muscle to relax. In this scenario, the downward pressure applied just above the elbow joint triggers the Golgi tendon reflex, resulting in the attacker's collapse. The other options are incorrect: - The myotatic reflex (also known as the stretch reflex) is responsible for contracting a muscle in response to its stretch, not relaxing it. - The withdrawal reflex is a spinal reflex that moves a body part away from a painful stimulus, not directly related to the scenario described. - The crossed-extensor reflex is a reflex that occurs on the opposite side of the body in response to a withdrawal reflex, which is not the case in this situation.

4. A nurse is preparing to administer terbutaline to a client who is experiencing preterm labor. Which of the following statements by the client is an indication that the medication is effective?

Correct answer: D

Rationale: Terbutaline is a tocolytic medication used to stop uterine contractions. The client stating that the contractions have stopped indicates that the medication is effective. Choices A, B, and C are incorrect because feeling stronger contractions, a racing heart, or decreased fetal movement are not signs of terbutaline effectiveness in managing preterm labor.

5. A client has been prescribed Aspirin for prevention of cardiovascular disease. Which of the following findings indicates the medication is effective?

Correct answer: C

Rationale: The correct answer is C. A decrease in episodes of angina indicates that Aspirin is effectively preventing the formation of clots that could lead to cardiovascular events. Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle, usually due to coronary artery disease. Aspirin works by inhibiting platelet aggregation, thereby reducing the risk of clot formation in the arteries. Improvement in angina symptoms suggests that the medication is successfully preventing clot-related complications in the cardiovascular system. Monitoring and recognizing a decrease in angina episodes can be a valuable indicator of the medication's efficacy in preventing cardiovascular events. Choices A, B, and D are incorrect because a decrease in troponin levels, a regular heart rhythm, or stable blood pressure, while important parameters, do not directly reflect the effectiveness of Aspirin in preventing cardiovascular events through antiplatelet action.

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