Nursing Elites

1. The nurse is caring for a client receiving anticoagulant therapy. Which instruction should the nurse reinforce with the client to prevent bleeding complications?

• A. Use a soft-bristle toothbrush and electric razor.
• B. Increase your intake of vitamin K-rich foods.
• C. Take aspirin if you have a headache.
• D. Avoid using ice packs for injuries.

Correct answer: A

Rationale: The correct instruction to prevent bleeding complications in a client on anticoagulant therapy is to use a soft-bristle toothbrush and an electric razor. These implements help reduce the risk of bleeding by being gentle on the skin and reducing the chances of cuts or abrasions that could lead to bleeding in individuals on anticoagulants. Choice B is incorrect because increasing intake of vitamin K-rich foods can interfere with the action of anticoagulants. Choice C is incorrect as aspirin is a blood thinner and can increase the risk of bleeding when combined with anticoagulant therapy. Choice D is incorrect as ice packs can help reduce bleeding and swelling in injuries, but in a client on anticoagulant therapy, it is important to avoid potential trauma to the skin that could lead to bleeding.

2. The client with a history of coronary artery disease (CAD) is scheduled for a stress test. What instruction should the nurse provide to the client before the test?

• A. Continue taking your usual dose of beta-blockers
• B. Refrain from eating or drinking anything for 4 hours before the test
• C. Wear loose, comfortable clothing and walking shoes
• D. Avoid any physical activity for 24 hours before the test

Correct answer: C

Rationale: Before a stress test, the nurse should instruct the client to wear loose, comfortable clothing and walking shoes. This is essential as the stress test involves physical exercise, and the client should be ready for the activity involved. Continuing beta-blockers should be based on healthcare provider's instructions; adjustments may be needed. Fasting before the test is usually not necessary. Avoiding physical activity for 24 hours before the test is not recommended as it may affect the accuracy of the test results by not providing a true reflection of the client's exercise capacity.

3. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value should the nurse monitor to assess the effectiveness of the medication?

• A. Activated partial thromboplastin time (aPTT)
• B. Prothrombin time (PT) and international normalized ratio (INR)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are the laboratory values used to monitor the effectiveness of warfarin therapy. These values help ensure that the client is within the therapeutic range for anticoagulation. PT measures the time it takes for blood to clot, while INR standardizes PT results to minimize variations between laboratories. Monitoring these values is crucial to prevent complications such as bleeding or clot formation. Activated partial thromboplastin time (aPTT) (Choice A) is more commonly used to monitor heparin therapy. Platelet count (Choice C) assesses the number of platelets in the blood and is not specific to warfarin therapy. Erythrocyte sedimentation rate (ESR) (Choice D) is a non-specific marker of inflammation and is not used to monitor the effectiveness of warfarin therapy.

4. Which statement indicates that a client with coronary artery disease (CAD) understands disease management?

• A. I will walk for one-half hour daily.
• B. As long as I exercise, I can eat anything I wish.
• C. My weight plays no role in this disease.
• D. My father's high cholesterol is irrelevant.

Correct answer: A

Rationale: Choice A is the correct answer because regular physical activity, such as walking for half an hour daily, is beneficial for managing coronary artery disease (CAD) and promoting heart health. Walking helps improve circulation, reduce cholesterol levels, and maintain a healthy weight, all of which are crucial for managing CAD. Choice B is incorrect because diet also plays a significant role in CAD management, not just exercise. Choice C is incorrect because weight management is essential in controlling CAD risk factors. Choice D is incorrect because family history of high cholesterol can increase the risk of CAD, making it relevant for disease management.

5. During an assessment, a client taking valproic acid exhibits elevated liver enzymes. What finding should the nurse report to the provider?

• A. Elevated liver enzymes
• B. Weight loss
• C. Dry mouth
• D. Increased appetite

Correct answer: A

Rationale: Elevated liver enzymes are a critical finding that the nurse should report to the provider when assessing a client taking valproic acid. It can be indicative of hepatotoxicity, a severe side effect associated with valproic acid use. Timely reporting and intervention are essential to prevent further complications and ensure the client's safety and well-being. Choices B, C, and D are not directly related to valproic acid use or the manifestation of hepatotoxicity. Weight loss, dry mouth, and increased appetite are not typically associated with elevated liver enzymes in the context of valproic acid administration.

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