Nursing Elites

1. The client on warfarin has an INR of 1.2. What is the nurse’s priority action?

• A. Increase the dose of warfarin
• B. Administer vitamin K
• C. Monitor for signs of bleeding
• D. Hold the next dose and notify the healthcare provider

Correct answer: A

Rationale: The correct answer is to increase the dose of warfarin. An INR of 1.2 is below the therapeutic range for a client on warfarin, indicating that the dose is subtherapeutic. The priority action in this situation is to adjust the dose to achieve the target therapeutic INR range (usually 2-3) to prevent thromboembolic events. Administering vitamin K is not necessary as the INR is low, and there are no signs of bleeding. Monitoring for signs of bleeding is important but not the priority in this case since the INR is subtherapeutic. Holding the next dose and notifying the healthcare provider would delay the intervention needed to adjust the dose and achieve the therapeutic range.

2. What is the amount of tension the ventricle must develop during contraction to eject blood from the left ventricle into the aorta?

• A. Afterload
• B. Preload
• C. Automaticity
• D. Ejection fraction

Correct answer: A

Rationale: Afterload is the correct answer because it refers to the pressure or tension that the ventricle must overcome during systole to eject blood into the aorta. Preload, on the other hand, is the degree of stretch of the ventricular muscle at the end of diastole before it contracts. Automaticity is the ability of the heart to generate electrical impulses independently, and ejection fraction is the percentage of blood pumped out of the ventricle with each heartbeat. Therefore, in the context of the question, afterload best describes the amount of tension the ventricle must develop to eject blood into the aorta.

3. Which heart chamber receives oxygenated blood from the four pulmonary veins and serves as a reservoir during ventricular systole?

• A. Right atrium
• B. Left atrium
• C. Right ventricle
• D. Left ventricle

Correct answer: B

Rationale: The correct answer is B, Left atrium. The left atrium receives oxygenated blood from the lungs via the four pulmonary veins and acts as a holding chamber before the blood is pumped into the left ventricle. Choice A, Right atrium, is incorrect as it receives deoxygenated blood from the body via the vena cava. Choices C and D, Right ventricle and Left ventricle, are incorrect as they receive blood from the atria, not the pulmonary veins.

4. What is the term that describes the inability of cardiac cells to respond to a new stimulus while they are still in contraction from a previous stimulus?

• A. Refractoriness
• B. Excitability
• C. Contractility
• D. Automaticity

Correct answer: A

Rationale: Refractoriness is the correct term to describe the inability of cardiac cells to respond to a new stimulus while they are still in contraction from a previous stimulus. This period is essential for the heart to complete its contraction and relaxation phases without interference. Excitability refers to the ability of cells to respond to stimuli, not the inability to respond. Contractility is the force of cardiac muscle contraction, and automaticity is the ability of cardiac cells to generate electrical impulses spontaneously, which are not relevant to the described scenario.

5. The client on spironolactone should avoid which of the following?

• A. Foods high in potassium
• B. Foods high in sodium
• C. Foods high in calcium
• D. Foods high in chloride

Correct answer: A

Rationale: The correct answer is A: Foods high in potassium. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium and excrete sodium. Consuming foods high in potassium while on spironolactone can lead to an excess of potassium in the body, potentially causing hyperkalemia. Choices B, C, and D are incorrect because spironolactone does not directly interact with sodium, calcium, or chloride in a way that would require specific dietary restrictions related to these minerals.

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