Nursing Elites

1. The client with a new prescription for warfarin (Coumadin) is receiving teaching from the LPN/LVN. Which statement by the client indicates an understanding of the medication?

• A. I will avoid eating foods high in vitamin K, like spinach and broccoli.
• B. I will take aspirin instead of acetaminophen for headaches while on this medication.
• C. I can stop taking the medication once my symptoms improve.
• D. I will double my dose if I miss a dose to catch up.

Correct answer: A

Rationale: Clients prescribed with warfarin (Coumadin) need to maintain a consistent intake of vitamin K and avoid sudden increases in foods rich in vitamin K as it can interfere with the effectiveness of the medication. Choice A, 'I will avoid eating foods high in vitamin K, like spinach and broccoli,' is the correct statement indicating an understanding of the medication. This choice demonstrates knowledge of the importance of consistent vitamin K intake to prevent fluctuations in warfarin's effectiveness. Choices B, C, and D are incorrect. Choice B suggests a substitution that is not advised without consulting a healthcare provider. Choice C is incorrect as stopping warfarin suddenly can lead to serious health risks. Choice D is unsafe and incorrect since doubling the dose is not the correct action if a dose is missed.

2. A client with chronic heart failure is being discharged with a prescription for digoxin (Lanoxin). Which instruction should the nurse reinforce?

• A. Take the medication at the same time each day.
• B. Avoid foods high in potassium.
• C. Skip a dose if you feel well.
• D. Take the medication on an empty stomach.

Correct answer: A

Rationale: Taking digoxin at the same time each day is essential to maintain a consistent blood level of the medication. This consistency helps optimize the therapeutic effects of digoxin in managing chronic heart failure. Deviating from the scheduled time could lead to fluctuations in drug levels, affecting its effectiveness and potentially causing harm. Choices B, C, and D are incorrect because avoiding potassium-rich foods, skipping doses when feeling well, and taking the medication on an empty stomach are not relevant or appropriate instructions for a client prescribed digoxin.

3. 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.

4. When teaching a client with a new prescription for spironolactone, which instruction should the nurse include?

• A. Increase your intake of potassium-rich foods.
• B. Avoid consuming grapefruit juice.
• C. Take the medication with food.
• D. Monitor for signs of hyperkalemia.

Correct answer: D

Rationale: The correct answer is to instruct the client to monitor for signs of hyperkalemia when taking spironolactone since it is a potassium-sparing diuretic. Hyperkalemia is a potential adverse effect due to the medication's mechanism of action. Advising the client to increase potassium-rich foods (Choice A) would be incorrect as it can further elevate potassium levels, which could lead to hyperkalemia. Avoiding grapefruit juice (Choice B) is not directly related to spironolactone use. Though taking the medication with food (Choice C) can help reduce gastrointestinal upset, it is not the most critical instruction when initiating spironolactone therapy.

5. A client with a history of coronary artery disease (CAD) is prescribed atorvastatin (Lipitor). The nurse should teach the client about which common side effect of this medication?

• A. Dry mouth
• B. Muscle pain
• C. Drowsiness
• D. Diarrhea

Correct answer: B

Rationale: Muscle pain is a common side effect of statins like atorvastatin. It is important for the nurse to educate the client about this potential side effect, as it can indicate a serious condition called rhabdomyolysis, which requires immediate medical attention. Dry mouth, drowsiness, and diarrhea are not typically associated with atorvastatin use.

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