Nursing Elites

1. The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage does the nurse instruct the client to select from the menu?

• A. Tea
• B. Cola
• C. Coffee
• D. Lemonade

Correct answer: D

Rationale: Lemonade is the correct choice as it is caffeine-free, unlike tea, cola, and coffee, which contain caffeine that can potentially affect the client's heart rhythm. Caffeine can increase heart rate and blood pressure, which may not be advisable for a client with a recent MI. Tea, cola, and coffee should be avoided due to their caffeine content, which can have stimulant effects on the heart and may not be beneficial for a client recovering from a myocardial infarction.

2. What preoperative instruction should the LPN/LVN reinforce to a client scheduled for a carotid endarterectomy?

• A. You will need to be NPO after midnight before the surgery.
• B. You should avoid deep breathing and coughing after the surgery.
• C. You will be able to eat and drink normally after the procedure.
• D. You can take all of your prescribed medications the morning of surgery.

Correct answer: A

Rationale: The correct preoperative instruction that the LPN/LVN should reinforce to a client scheduled for a carotid endarterectomy is being NPO after midnight before the surgery. This instruction is essential to prevent aspiration and ensure a safe procedure. Avoiding oral intake helps reduce the risk of complications during anesthesia induction and the surgical process. Choices B, C, and D are incorrect because avoiding deep breathing and coughing, resuming normal eating and drinking, and taking all prescribed medications the morning of surgery are not recommended preoperative instructions for a carotid endarterectomy.

3. The client with atrial fibrillation is receiving warfarin (Coumadin). Which laboratory test should be monitored to determine the effectiveness of the therapy?

• A. Prothrombin time (PT) and international normalized ratio (INR)
• B. Activated partial thromboplastin time (aPTT)
• C. Complete blood count (CBC)
• D. Fibrinogen level

Correct answer: A

Rationale: Monitoring Prothrombin time (PT) and international normalized ratio (INR) is crucial when a client is on warfarin therapy. These tests assess the clotting ability of the blood and help determine the appropriate dosage of warfarin to prevent complications such as bleeding or clotting events. PT and INR values within the therapeutic range indicate the effectiveness of warfarin in managing atrial fibrillation. Choice B, activated partial thromboplastin time (aPTT), is not typically used to monitor warfarin therapy; it is more commonly used to assess the effectiveness of heparin therapy. Choice C, complete blood count (CBC), does not directly assess the anticoagulant effect of warfarin. Choice D, fibrinogen level, is not a primary test for monitoring warfarin therapy; it is more relevant in assessing conditions like disseminated intravascular coagulation.

4. The healthcare provider is reinforcing teaching for a client who is starting statin therapy. Which dietary advice should the healthcare provider give?

• A. Eat more whole grains.
• B. Avoid foods high in potassium.
• C. Avoid grapefruit and grapefruit juice.
• D. Increase intake of dairy products.

Correct answer: C

Rationale: The correct answer is C: Avoid grapefruit and grapefruit juice. Grapefruit and grapefruit juice can interfere with the metabolism of statins, leading to an increased risk of adverse effects. It is crucial for clients on statin therapy to avoid grapefruit products to ensure the medication's effectiveness and safety. Choices A, B, and D are incorrect because they do not directly impact the metabolism or effectiveness of statin therapy.

5. A client with a history of congestive heart failure (CHF) is receiving digoxin (Lanoxin). The nurse should monitor the client for which sign of digoxin toxicity?

• A. Hypertension
• B. Bradycardia
• C. Hyperglycemia
• D. Insomnia

Correct answer: B

Rationale: Bradycardia is a common sign of digoxin toxicity. Digoxin can cause bradycardia due to its effects on the heart's electrical conduction system. The nurse should closely monitor the client's heart rate for any signs of slowing down, as it can indicate toxicity and potentially lead to serious complications. Hypertension, hyperglycemia, and insomnia are not typically associated with digoxin toxicity. Hypertension is more commonly associated with other conditions or medications, hyperglycemia can be seen in conditions like diabetes or certain medications, and insomnia is not a typical sign of digoxin toxicity.

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