Nursing Elites

1. A client with a new prescription for simvastatin is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should take this medication in the evening.'
• B. 'I should avoid drinking grapefruit juice.'
• C. 'I should expect my urine to be red-orange while taking this medication.'
• D. 'I will need to take this medication for the rest of my life.'

Correct answer: A

Rationale: The correct answer is A. Taking simvastatin in the evening is recommended because cholesterol synthesis increases at night. This timing maximizes the effectiveness of the medication in lowering cholesterol levels. Choice B is incorrect because grapefruit juice should be avoided with certain statins, but simvastatin is not significantly affected by grapefruit juice. Choice C is incorrect as red-orange urine is not an expected side effect of simvastatin. Choice D is incorrect because simvastatin is typically prescribed for managing cholesterol levels and may not need to be taken for the rest of the client's life.

2. What preoperative instruction should the LPN/LVN reinforce to a client scheduled for a carotid endarterectomy?

• A. You will need to be NPO after midnight before the surgery.
• B. You should avoid deep breathing and coughing after the surgery.
• C. You will be able to eat and drink normally after the procedure.
• D. You can take all of your prescribed medications the morning of surgery.

Correct answer: A

Rationale: The correct preoperative instruction that the LPN/LVN should reinforce to a client scheduled for a carotid endarterectomy is being NPO after midnight before the surgery. This instruction is essential to prevent aspiration and ensure a safe procedure. Avoiding oral intake helps reduce the risk of complications during anesthesia induction and the surgical process. Choices B, C, and D are incorrect because avoiding deep breathing and coughing, resuming normal eating and drinking, and taking all prescribed medications the morning of surgery are not recommended preoperative instructions for a carotid endarterectomy.

3. The client is receiving anticoagulant therapy for atrial fibrillation. Which laboratory test should be monitored to determine the effectiveness of the therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: A

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of anticoagulant therapy in clients with atrial fibrillation. These tests help ensure that the client is within the therapeutic range and are commonly used to assess the clotting ability of the blood. Monitoring PT and INR levels allows healthcare providers to adjust anticoagulant dosages as needed to prevent complications such as bleeding or thrombosis. Activated partial thromboplastin time (aPTT) is more commonly used to monitor heparin therapy, not anticoagulant therapy for atrial fibrillation. Platelet count assesses the number of platelets in the blood and is not a direct indicator of anticoagulant therapy effectiveness. Erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and is not used to monitor anticoagulant therapy.

4. The client has atrial fibrillation and is receiving warfarin (Coumadin) therapy. Which laboratory test should be monitored to evaluate the effectiveness of the warfarin therapy?

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

Correct answer: A

Rationale: Monitoring the Prothrombin time (PT) and international normalized ratio (INR) is crucial for assessing the effectiveness of warfarin therapy. These tests help determine the clotting ability of the blood and ensure that the client is within the desired therapeutic range to prevent clotting events or bleeding complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy, not warfarin. Complete blood count (CBC) (Choice C) and fibrinogen levels (Choice D) do not directly assess the effectiveness of warfarin therapy in the same way that PT and INR do.

5. The client will wear a Holter monitor for continuous cardiac monitoring over the next 24 hours. What action should the nurse take to assist the client?

• A. Shave the front of the client's chest
• B. Give the client a device holder to wear around the waist
• C. Teach the client to rest as much as possible during the next 24 hours
• D. Tell the client to cover the monitor in plastic wrap before taking a bath

Correct answer: B

Rationale: Providing the client with a device holder to wear around the waist allows them to comfortably carry the Holter monitor while engaging in normal activities throughout the 24-hour monitoring period. This approach supports the client's mobility and ensures the monitor is securely in place for accurate readings. Shaving the front of the client's chest is unnecessary and not a standard practice for Holter monitor placement. Instructing the client to rest as much as possible does not promote normal daily activities which are important for accurate monitoring. Covering the monitor in plastic wrap before bathing is not recommended as it may affect the functionality of the device.

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