Nursing Elites

1. The client on warfarin has an INR of 4.5. What is the most appropriate action by the nurse?

• A. Administer vitamin K.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Monitor the client’s INR closely.

Correct answer: A

Rationale: An INR of 4.5 is elevated, indicating an increased risk of bleeding due to excessive anticoagulation. The most appropriate action for the nurse in this scenario is to administer vitamin K. Vitamin K helps reverse the anticoagulant effects of warfarin, thus lowering the INR and reducing the risk of bleeding. Holding the next dose of warfarin (choice B) is not sufficient to address the immediate high INR level. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the risk of bleeding. While monitoring the client's INR closely (choice D) is important, immediate action is required to address the critically high INR level, making the administration of vitamin K the priority intervention.

2. What is the term for the amount of blood ejected by the left ventricle into the aorta per beat, determined by preload, contractility, and afterload?

• A. Stroke volume
• B. Cardiac output
• C. End-diastolic volume
• D. Ejection fraction

Correct answer: A

Rationale: The correct answer is A: Stroke volume. Stroke volume refers to the volume of blood ejected by the left ventricle during each heartbeat. This is determined by preload (the degree of stretch of the cardiac muscle fibers at the end of diastole), contractility (the force of myocardial contraction), and afterload (the pressure or resistance that the ventricle must overcome to eject blood). Choice B, Cardiac output, is the volume of blood pumped by the heart per minute and is calculated by multiplying the heart rate by the stroke volume. Choice C, End-diastolic volume, is the volume of blood in the ventricle at the end of diastole before contraction. Choice D, Ejection fraction, is the proportion of blood pumped out of the ventricle with each contraction, calculated by dividing the stroke volume by the end-diastolic volume.

3. The client on warfarin has an INR of 5.5. What is the priority nursing action?

• A. Administer vitamin K as an antidote.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Administer fresh frozen plasma.

Correct answer: A

Rationale: An INR of 5.5 is significantly elevated, indicating an increased risk of bleeding. The priority nursing action in this situation is to administer vitamin K as an antidote to reverse the effects of warfarin and lower the INR. Holding the next dose of warfarin (choice B) is important but not as immediate as administering vitamin K. Increasing the dose of warfarin (choice C) would further elevate the INR, worsening the bleeding risk. Administering fresh frozen plasma (choice D) is not the first-line treatment for high INR due to warfarin.

4. The client on enoxaparin (Lovenox) is scheduled for surgery. What is the nurse’s priority action?

• A. Hold the enoxaparin and notify the healthcare provider.
• B. Administer the enoxaparin as scheduled.
• C. Administer vitamin K before the surgery.
• D. Monitor the client’s INR and proceed with surgery.

Correct answer: A

Rationale: The correct answer is A: Hold the enoxaparin and notify the healthcare provider. Enoxaparin, being an anticoagulant, should be held before surgery to reduce the risk of excessive bleeding during the procedure. It is crucial to inform the healthcare provider to determine the appropriate management plan. Choice B is incorrect because administering enoxaparin before surgery can increase the risk of bleeding. Choice C is incorrect as vitamin K administration is not typically indicated in this situation. Choice D is incorrect because monitoring the client's INR and proceeding with surgery without addressing the enoxaparin can lead to significant bleeding complications.

5. Which artery supplies the anterior wall of the left ventricle, the anterior interventricular septum, the anterior papillary muscles, and apex of the heart?

• A. Left anterior descending artery
• B. Left circumflex artery
• C. Posterior descending artery
• D. Aortic artery

Correct answer: A

Rationale: The correct answer is the Left anterior descending artery. This artery supplies the anterior wall of the left ventricle, the anterior interventricular septum, the anterior papillary muscles, and apex of the heart. The Left circumflex artery (choice B) supplies the lateral and posterior walls of the left ventricle, the posterior descending artery (choice C) supplies the inferior part of the heart, and the aortic artery (choice D) is not a specific coronary artery.

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