Nursing Elites

1. The client is on warfarin and has an INR of 1.5. What is the nurse’s priority action?

• A. Increase the dose of warfarin.
• B. Hold the next dose of warfarin.
• C. Continue the current dose of warfarin.
• D. Monitor the client’s INR closely.

Correct answer: B

Rationale: An INR of 1.5 is below the therapeutic range for a client on warfarin, indicating that the client may be at risk of clot formation. The nurse's priority action should be to hold the next dose of warfarin to prevent further reduction of the INR. Increasing the dose could potentially lead to an increased risk of bleeding, and continuing the current dose may not be sufficient to bring the INR within the therapeutic range. Monitoring the client's INR closely is important but not the priority action in this scenario.

2. Which term conceptualizes that the greater the myocardial fiber stretch, within physiologic limits, the more forceful the ventricular contraction, thereby increasing stroke volume?

• A. Frank-Starling’s Law
• B. Automaticity
• C. Contractility
• D. Excitability

Correct answer: A

Rationale: The correct answer is A, Frank-Starling’s Law. This law explains that within physiologic limits, the greater the stretch of myocardial fibers, the more forceful the ventricular contraction, leading to an increased stroke volume. Choice B, Automaticity, refers to the ability of cardiac cells to spontaneously generate electrical impulses. Choice C, Contractility, represents the intrinsic ability of the heart muscle to contract. Choice D, Excitability, refers to the ability of cardiac cells to respond to electrical stimuli.

3. What procedure is used to remove fluid from the pleural space to help a patient breathe more easily?

• A. Thoracentesis
• B. Bronchoscopy
• C. Echocardiogram
• D. CT scan

Correct answer: A

Rationale: Thoracentesis is the correct answer. It is a procedure where a needle is inserted into the pleural space to drain fluid, relieving pressure and helping the patient breathe more easily. Bronchoscopy (choice B) is a procedure used to examine the airways, not to drain fluid. An echocardiogram (choice C) is an imaging test to assess the heart's structure and function, not related to draining pleural fluid. A CT scan (choice D) is a cross-sectional imaging test that provides detailed pictures of the inside of the body, not used for draining pleural fluid.

4. What is the term for a blood clot blocking an artery in the lungs, leading to symptoms like shortness of breath and chest pain?

• A. Pulmonary embolism
• B. Deep vein thrombosis (DVT)
• C. Myocardial infarction
• D. Pneumothorax

Correct answer: A

Rationale: The correct answer is A, pulmonary embolism. A pulmonary embolism occurs when a blood clot travels to the lungs and blocks an artery, causing symptoms like shortness of breath and chest pain. Choice B, deep vein thrombosis (DVT), involves a blood clot forming in a deep vein, usually in the legs. Choice C, myocardial infarction, refers to a heart attack due to blocked blood flow to the heart muscle. Choice D, pneumothorax, is a collapsed lung due to air leaking into the chest cavity.

5. The client is on enalapril (Vasotec) for hypertension. What side effect is most commonly associated with this medication?

• A. Dry cough
• B. Hypotension
• C. Hyperkalemia
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Dry cough. A dry cough is a common side effect of ACE inhibitors like enalapril. ACE inhibitors can cause the accumulation of bradykinin, leading to irritation of the respiratory tract and resulting in a persistent dry cough. Hypotension (choice B) is a possible side effect of ACE inhibitors but is less common than a dry cough. Hyperkalemia (choice C) is another side effect of ACE inhibitors, but it is not the most commonly associated one. Headache (choice D) is not a common side effect of enalapril compared to a dry cough. Therefore, the most commonly associated side effect with enalapril is a dry cough.

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