Nursing Elites

1. The nurse is assisting with the care of a client who is on a continuous heparin infusion for deep vein thrombosis (DVT). Which laboratory test should the nurse monitor to evaluate the effectiveness of the therapy?

• A. Prothrombin time (PT)
• B. Activated partial thromboplastin time (aPTT)
• C. International normalized ratio (INR)
• D. Platelet count

Correct answer: B

Rationale: To evaluate the effectiveness of heparin therapy in a client with DVT, the nurse should monitor the activated partial thromboplastin time (aPTT). The aPTT test helps ensure that the dose of heparin is within the therapeutic range, which is essential for preventing clot formation or excessive bleeding. Monitoring aPTT is crucial in managing patients on heparin therapy to maintain the delicate balance between preventing thrombosis and avoiding hemorrhage. Prothrombin time (PT) and International normalized ratio (INR) are more indicative of warfarin therapy effectiveness, not heparin. Platelet count assesses platelet levels and function, not the effectiveness of heparin therapy for DVT.

2. A client with a history of heart failure is prescribed metoprolol (Lopressor). The nurse should monitor the client for which common side effect of this medication?

• A. Tachycardia
• B. Hypotension
• C. Hypertension
• D. Hyperglycemia

Correct answer: B

Rationale: Metoprolol is a beta-blocker commonly used in heart failure to reduce blood pressure. One of the common side effects of metoprolol is hypotension, which can lead to dizziness, lightheadedness, and even fainting. Therefore, monitoring for hypotension is essential to prevent adverse effects and ensure patient safety. Choices A, C, and D are incorrect. Tachycardia is not a common side effect of metoprolol, as it actually reduces heart rate. Hypertension is also not a common side effect of this medication, as it is intended to lower blood pressure. Hyperglycemia is not a typical side effect of metoprolol.

3. The LPN/LVN is reinforcing discharge instructions to a client who has been prescribed nitroglycerin sublingual tablets for angina. Which statement by the client indicates a need for further teaching?

• A. I will keep my nitroglycerin tablets in the original glass bottle.
• B. I will sit or lie down when I take a nitroglycerin tablet.
• C. I will take a nitroglycerin tablet every 5 minutes if chest pain persists, up to a total of 3 tablets.
• D. I can swallow the nitroglycerin tablet with a glass of water if it does not dissolve quickly.

Correct answer: D

Rationale: The correct answer is D. Nitroglycerin sublingual tablets should not be swallowed; they must dissolve under the tongue to be effective. Choice A is correct as nitroglycerin tablets should be stored in their original glass container to prevent degradation. Choice B is correct as sitting or lying down when taking a nitroglycerin tablet helps prevent dizziness or fainting due to a sudden drop in blood pressure. Choice C is correct as taking a nitroglycerin tablet every 5 minutes for a maximum of 3 tablets is the correct protocol for managing angina symptoms.

4. A client is taking haloperidol. Which of the following findings should the nurse report to the provider?

• A. Weight gain
• B. Dry mouth
• C. Tremors
• D. Tardive dyskinesia

Correct answer: D

Rationale: The correct answer is D: Tardive dyskinesia. Tardive dyskinesia is a serious side effect associated with the long-term use of haloperidol. It is characterized by involuntary movements of the face, tongue, and extremities. Early detection is crucial as tardive dyskinesia may be irreversible and should be reported promptly to the healthcare provider for further evaluation and management. Choices A, B, and C are incorrect because weight gain, dry mouth, and tremors are common side effects of haloperidol but are not as concerning as tardive dyskinesia. While they should still be monitored and managed, tardive dyskinesia requires immediate attention due to its potentially irreversible nature.

5. The LPN/LVN is assisting in the care of a client who has been prescribed enoxaparin (Lovenox) for the prevention of deep vein thrombosis (DVT). Which instruction should the nurse reinforce with the client?

• A. Avoid consuming foods high in vitamin K while taking this medication.
• B. Administer the injection in the same site each time for consistency.
• C. Report any unusual bleeding or bruising to your healthcare provider.
• D. Do not take aspirin if you experience any mild pain or discomfort.

Correct answer: C

Rationale: The correct instruction for the nurse to reinforce with the client is to report any unusual bleeding or bruising to their healthcare provider. This is crucial because unusual bleeding or bruising may indicate excessive anticoagulation, a potential side effect of enoxaparin. Prompt reporting to a healthcare provider is necessary to prevent complications. Choices A, B, and D are incorrect. Choice A is not directly related to enoxaparin and vitamin K interactions. Choice B is incorrect as rotating injection sites is essential for preventing tissue damage and irritation. Choice D is also incorrect as aspirin can increase the risk of bleeding when taken with enoxaparin.

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