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. Which condition involves the tearing of the aorta, leading to severe pain and internal bleeding?

• A. Aortic dissection
• B. Aneurysm
• C. Stroke
• D. Myocardial infarction

Correct answer: A

Rationale: The correct answer is Aortic dissection. Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, causing severe chest or back pain and internal bleeding, requiring immediate medical attention. Choice B, aneurysm, involves a bulging or weakening of a blood vessel wall, which is different from a tear in the aorta. Choices C and D, stroke and myocardial infarction, do not directly involve the tearing of the aorta and are distinct conditions.

3. What is a chronic condition where the heart is unable to pump blood effectively, leading to fluid buildup in the lungs and other parts of the body?

• A. Heart failure
• B. Myocardial infarction
• C. Pericarditis
• D. Pulmonary edema

Correct answer: A

Rationale: The correct answer is A: Heart failure. Heart failure is a chronic condition characterized by the heart's inability to pump blood effectively, resulting in fluid accumulation in the lungs and other body tissues. Myocardial infarction (choice B) refers to a heart attack caused by a blocked coronary artery, leading to damage of heart muscle tissue. Pericarditis (choice C) is the inflammation of the pericardium, the protective sac around the heart. Pulmonary edema (choice D) is a condition where fluid builds up in the lungs, often as a result of heart failure.

4. The nurse is caring for a client on amiodarone who develops a cough. What is the most appropriate action?

• A. Notify the healthcare provider immediately.
• B. Reassure the client that this is a common side effect.
• C. Continue the amiodarone and monitor the client’s symptoms.
• D. Discontinue the amiodarone immediately.

Correct answer: A

Rationale: The correct action when a client on amiodarone develops a cough, which can be a sign of pulmonary toxicity, a serious side effect of amiodarone, is to notify the healthcare provider immediately. This is crucial because pulmonary toxicity can lead to severe complications if not addressed promptly. Choices B and C are incorrect as they do not address the potential severity of the situation and may delay necessary intervention. Choice D of discontinuing amiodarone immediately without consulting the healthcare provider can be risky, as sudden discontinuation of the medication may have adverse effects on the client's condition.

5. What is a condition where the heart's electrical impulses are delayed or blocked, leading to a slower or irregular heartbeat?

• A. Heart block
• B. Tachycardia
• C. Bradycardia
• D. Arrhythmia

Correct answer: A

Rationale: Heart block is the correct answer because it specifically refers to a condition where the heart's electrical impulses are delayed or blocked, resulting in a slower or irregular heartbeat. Tachycardia (choice B) is a condition characterized by a fast heart rate, Bradycardia (choice C) is a slow heart rate, and Arrhythmia (choice D) is a general term used to describe any abnormal heart rhythm, which may or may not involve delays or blocks in electrical impulses.

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