Nursing Elites

1. 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.

2. What is a condition where the lung's air sacs (alveoli) are damaged and enlarged, leading to breathlessness?

• A. Emphysema
• B. Chronic bronchitis
• C. Asthma
• D. Pulmonary fibrosis

Correct answer: A

Rationale: Emphysema is the correct answer. It is a condition where the air sacs in the lungs are damaged and enlarged, leading to breathlessness. Chronic bronchitis is characterized by inflammation of the bronchial tubes, not the alveoli. Asthma involves airway inflammation and constriction, not alveolar damage. Pulmonary fibrosis is a condition where lung tissue becomes thickened and scarred, different from the alveolar damage seen in emphysema.

3. What is a condition where the heart's ability to pump blood is decreased, leading to fluid buildup in the lungs and other parts of the body?

• A. Heart failure
• B. Cardiomyopathy
• C. Pericarditis
• D. Myocarditis

Correct answer: A

Rationale: The correct answer is A, heart failure. Heart failure is a condition where the heart is unable to pump blood effectively, leading to fluid accumulation in the lungs and other areas. Choice B, Cardiomyopathy, refers to diseases of the heart muscle. Choices C and D, Pericarditis and Myocarditis, respectively, are conditions involving inflammation of the outer lining of the heart and the heart muscle itself, which may not always directly result in decreased pumping ability like heart failure does.

4. The client on clopidogrel (Plavix) should be monitored for which adverse effect?

• A. Bleeding
• B. Hypertension
• C. Tachycardia
• D. Bradycardia

Correct answer: A

Rationale: Correct! Clopidogrel (Plavix) is an antiplatelet medication that helps prevent blood clots. As a side effect, it can increase the risk of bleeding. Monitoring for signs of bleeding, such as easy bruising, blood in urine or stools, or prolonged bleeding from cuts, is crucial. Choices B, C, and D are incorrect as hypertension, tachycardia, and bradycardia are not typically associated with clopidogrel use.

5. What is the ability of cardiac cells to respond to an impulse by transmitting the impulse along cell membranes?

• A. Contractility
• B. Automaticity
• C. Conductivity
• D. Rhythmicity

Correct answer: C

Rationale: The correct answer is C, Conductivity. Conductivity refers to the ability of cardiac cells to transmit impulses along cell membranes. Contractility (Choice A) is the ability of cardiac cells to contract in response to an electrical stimulus, not transmit impulses. Automaticity (Choice B) is the ability of cardiac cells to spontaneously generate electrical impulses. Rhythmicity (Choice D) refers to the regular generation of electrical impulses by the heart's pacemaker cells, not the transmission of impulses along cell membranes.

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