Nursing Elites

1. A young adult female client is seen in the emergency department for a minor injury following a motor vehicle collision. She states she is very angry at the person who hit her car. What is the best nursing response?

• A. You are lucky to be alive. Be grateful no one was killed.'
• B. I understand your car was not seriously damaged.'
• C. You are upset that this incident has brought you here.'
• D. Have you ever been in the emergency department before?'

Correct answer: C

Rationale: Validating the client's feelings can help her express and manage her emotions effectively.

2. A client with heart failure is prescribed digoxin (Lanoxin). Which instruction should the nurse include in the client's teaching plan?

• A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute.
• B. Increase your intake of foods high in potassium.
• C. Take the medication with a high-fiber meal to enhance absorption.
• D. Skip a dose if you feel dizzy or lightheaded.

Correct answer: A

Rationale: The correct instruction for a client prescribed digoxin is to take their pulse before each dose and hold the medication if the pulse is below 60 beats per minute. This is crucial to prevent digoxin toxicity, as digoxin can cause adverse effects when the pulse rate is too low. Monitoring the pulse regularly ensures safety and appropriate management of the medication.

3. A client's healthcare provider has ordered a 'liver panel' in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select one that doesn't apply.

• A. Alanine aminotransferase (ALT)
• B. C-reactive protein (CRP)
• C. Gamma-glutamyl transferase (GGT)
• D. Aspartate aminotransferase (AST)

Correct answer: B

Rationale: A 'liver panel' is a group of blood tests used to evaluate liver function. The components typically include ALT, GGT, and AST. While C-reactive protein (CRP) is a marker of inflammation and not part of a standard liver panel, it may be ordered for other diagnostic purposes.

4. In a patient with a history of chronic iron deficiency anemia requiring a recent blood transfusion and an extensive GI work-up, which statement is true based on their medications?

• A. A dedicated small bowel series has a high likelihood of being positive
• B. 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor
• C. The patient should have a provocative arteriogram with heparin infusion to identify the source of blood loss
• D. Hormonal therapy has been shown to be effective in decreasing blood loss due to arteriovenous malformations

Correct answer: B

Rationale: The correct answer is B. Taking even a low dose of aspirin per day, such as 81 mg, can reduce the protective effect on the gastrointestinal mucosa that is gained from using a COX II selective inhibitor. Aspirin can increase the risk of gastrointestinal bleeding, which can counteract the benefits of COX II inhibitors in protecting the stomach lining.

5. What is the primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT)?

• A. No need for regular INR monitoring
• B. Lower risk of bleeding
• C. Fewer dietary restrictions
• D. Longer half-life

Correct answer: A

Rationale: The primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT) is that rivaroxaban does not require regular INR monitoring. This eliminates the need for frequent blood tests to adjust the dosage, making it more convenient for patients to manage their anticoagulant therapy.

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