Nursing Elites

1. How should bleeding in a patient on warfarin be monitored?

• A. Monitor INR levels
• B. Monitor hemoglobin levels
• C. Monitor potassium levels
• D. Monitor platelet count

Correct answer: A

Rationale: The correct answer is to monitor INR levels. INR levels are the most critical indicator for monitoring bleeding risk in patients on warfarin. INR stands for International Normalized Ratio and specifically measures the clotting tendency of the blood. Monitoring hemoglobin levels, potassium levels, or platelet count are not as directly relevant to assessing bleeding risk in patients on warfarin.

2. A nurse is caring for a client who has an indwelling urinary catheter. Which of the following interventions should the nurse implement to prevent catheter-associated infections?

• A. Change the catheter every 24 hours
• B. Ensure the drainage bag is positioned above the bladder
• C. Perform routine irrigation of the catheter
• D. Empty the drainage bag every 4 hours

Correct answer: B

Rationale: The correct answer is to ensure the drainage bag is positioned above the bladder. This positioning prevents urine reflux into the bladder, reducing the risk of catheter-associated infections. Changing the catheter too frequently (Choice A) can actually increase the risk of infection by introducing pathogens. Performing routine catheter irrigation (Choice C) is no longer recommended as it can increase the risk of infection by introducing bacteria. Emptying the drainage bag every 4 hours (Choice D) is a standard practice to prevent urinary stasis but is not directly related to preventing catheter-associated infections.

3. A nurse is providing teaching about digoxin administration to the parents of a toddler with heart failure. Which of the following statements should the nurse include?

• A. Limit your child's potassium intake while taking this medication.
• B. You can mix the medication with a half-cup of your child's favorite juice.
• C. Do not repeat the dose if your child vomits within one hour after taking the medication.
• D. Have your child drink a small glass of water after swallowing the medication.

Correct answer: D

Rationale: The correct statement to include in the teaching about digoxin administration is to have the child drink a small glass of water after swallowing the medication. Water helps flush down the medication, preventing irritation in the esophagus. Choice A is incorrect because digoxin may interact with potassium levels, but strict restriction is not necessary. Choice B is incorrect as medications should not be mixed with juices unless specified by the healthcare provider due to possible interactions. Choice C is incorrect because if a child vomits after taking digoxin, the dose should not be repeated to avoid double dosing.

4. A nurse is reviewing the laboratory report of a client who has been taking lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the nurse expect?

• A. Withhold the next dose
• B. Increase the dosage
• C. Discontinue the medication
• D. Administer the medication

Correct answer: D

Rationale: The correct answer is to administer the medication (Choice D) since the lithium level of 0.8 mEq/L falls within the therapeutic range of 0.6-1.2 mEq/L. Withholding the next dose (Choice A) or increasing the dosage (Choice B) is not necessary as the current level is appropriate. Discontinuing the medication (Choice C) is not warranted based on the given lithium level. It is crucial to maintain therapeutic levels to ensure the medication's effectiveness without causing toxicity.

5. A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following statements should the nurse include?

• A. You should avoid drinking alcohol while taking this medication.
• B. You should monitor for signs of infection.
• C. Take this medication with food to prevent gastrointestinal upset.
• D. Take this medication with a full glass of water.

Correct answer: B

Rationale: The correct statement the nurse should include when teaching a client taking clopidogrel is to monitor for signs of infection. Clopidogrel affects platelet levels and can increase the risk of bleeding. Monitoring for signs of infection is crucial because a compromised immune system can make the client more susceptible to infections. Choices A, C, and D are incorrect because clopidogrel is not directly linked to alcohol restrictions, food requirements, or specific water intake instructions.

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