Nursing Elites

1. A patient is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

• A. Hemoglobin
• B. Prothrombin time (PT)
• C. Bleeding time
• D. Activated partial thromboplastin time (aPTT)

Correct answer: B

Rationale: The correct answer is to monitor Prothrombin time (PT) when a patient is on warfarin therapy. Warfarin affects blood clotting, and PT is used to assess the therapeutic effect of this medication. Hemoglobin (Choice A) is not directly affected by warfarin therapy and does not reflect its therapeutic effect. Bleeding time (Choice C) measures the time it takes for bleeding to stop after a standardized cut and is not specific to warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice D) is more commonly used to monitor heparin therapy, not warfarin.

2. A client is receiving heparin therapy. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the therapy?

• A. PT
• B. aPTT
• C. INR
• D. Platelet count

Correct answer: B

Rationale: The corrected answer is B: aPTT. The activated partial thromboplastin time (aPTT) is the laboratory value used to monitor the effectiveness of heparin therapy. The aPTT should be maintained at 1.5 to 2 times the normal level to ensure therapeutic anticoagulation. Monitoring aPTT helps healthcare providers adjust heparin doses to achieve the desired anticoagulant effects and prevent complications such as bleeding or clotting. Choice A, PT (prothrombin time), is used to monitor warfarin therapy, not heparin. Choice C, INR (international normalized ratio), is also used to monitor warfarin therapy. Choice D, platelet count, is important for assessing the risk of bleeding, but it does not directly monitor the effectiveness of heparin therapy.

3. A client has a new prescription for Calcitonin-salmon for postmenopausal osteoporosis. Which of the following instructions should the nurse include in the teaching?

• A. Swallow tablets on an empty stomach with plenty of water.
• B. Watch for skin rash and redness when applying calcitonin-salmon topically.
• C. Mix the liquid medication with juice and take it after meals.
• D. Alternate nostrils each time calcitonin-salmon is inhaled.

Correct answer: D

Rationale: Calcitonin-salmon is commonly administered intranasally for postmenopausal osteoporosis. It is essential to alternate nostrils daily when inhaling the medication to ensure equal distribution and optimal absorption. This technique helps prevent irritation and congestion in one nostril and enhances the effectiveness of the medication. Choices A, B, and C are incorrect because calcitonin-salmon is not swallowed, applied topically, or taken as a liquid medication after meals. Therefore, instructing the client to alternate nostrils during inhalation is the most appropriate teaching for this medication.

4. A healthcare professional is monitoring a client who is receiving spironolactone. Which of the following findings should the professional report to the provider?

• A. Serum Sodium 144 mEq/L
• B. Urine output 120 mL in 4 hours
• C. Serum Potassium 5.2 mEq/L
• D. Blood Pressure 140/90 mm Hg

Correct answer: C

Rationale: A serum potassium level of 5.2 mEq/L indicates hyperkalemia, which is a potentially dangerous condition. Spironolactone, a potassium-sparing diuretic, can cause potassium retention, leading to hyperkalemia. This electrolyte imbalance can result in serious consequences such as cardiac dysrhythmias. The healthcare professional should promptly report this finding to the provider, withhold the medication, and take appropriate actions to prevent complications. Monitoring and managing potassium levels are crucial in clients receiving spironolactone. The other options do not directly relate to the potential adverse effects of spironolactone and are within normal limits, making them less urgent to report.

5. A client has a new prescription for Alendronate. Which of the following instructions should be included in the discharge teaching?

• A. Take this medication at bedtime.
• B. Remain upright for 30 minutes after taking the medication.
• C. Take this medication with food.
• D. Increase your intake of calcium-rich foods.

Correct answer: B

Rationale: The correct answer is to instruct the client to remain upright for 30 minutes after taking Alendronate. This medication can cause esophageal irritation, and maintaining an upright position for at least 30 minutes helps prevent complications such as esophagitis or esophageal ulcers. Choice A is incorrect because Alendronate should be taken in the morning on an empty stomach. Choice C is incorrect because Alendronate should be taken on an empty stomach, preferably 30 minutes before the first food, beverage, or medication of the day. Choice D is incorrect because while calcium intake is important, it is not a specific instruction related to taking Alendronate.

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