Nursing Elites

1. The nurse is caring for a client on warfarin with an INR of 5.2. What is the most appropriate action?

• A. Administer vitamin K as an antidote.
• B. Hold the next dose of warfarin.
• C. Increase the dose of warfarin.
• D. Monitor the client’s INR closely.

Correct answer: A

Rationale: An INR of 5.2 is elevated, indicating an increased risk of bleeding. Administering vitamin K can help reverse the effects of warfarin, which is the most appropriate action in this situation. Holding the next dose of warfarin is not enough to address the high INR, and increasing the dose would further elevate the INR level. Monitoring the INR closely is important, but in this case, immediate action is needed to counteract the anticoagulant effects of warfarin.

2. The client is on a calcium channel blocker. What is the expected effect on the heart?

• A. Increased heart rate
• B. Decreased heart rate
• C. Increased blood pressure
• D. Decreased blood pressure

Correct answer: D

Rationale: When a client is on a calcium channel blocker, the expected effect on the heart is a decreased heart rate and decreased blood pressure. Calcium channel blockers work by dilating blood vessels and reducing the heart's workload, resulting in decreased blood pressure. Choice A, increased heart rate, is incorrect as calcium channel blockers actually have a negative chronotropic effect, reducing the heart rate. Choice C, increased blood pressure, is also incorrect because these medications are used to lower blood pressure.

3. What procedure involves inserting a needle into the pleural space to remove excess fluid and help the patient breathe more easily?

• A. Thoracentesis
• B. Bronchoscopy
• C. Spirometry
• D. Arterial blood gas (ABG)

Correct answer: A

Rationale: Thoracentesis is the correct answer. It is a procedure where a needle is inserted into the pleural space to remove excess fluid, aiding in easier breathing. Bronchoscopy (Choice B) is a procedure to visualize the airways and diagnose lung problems, not specifically for fluid drainage. Spirometry (Choice C) is a test to measure lung function, not a procedure for fluid removal. Arterial blood gas (ABG) (Choice D) is a blood test to assess oxygen and carbon dioxide levels in the blood, not a procedure for draining fluid from the pleural space.

4. When administering furosemide (Lasix) to a client, which lab value is most important to monitor?

• A. Potassium
• B. Sodium
• C. Calcium
• D. Chloride

Correct answer: A

Rationale: When administering furosemide (Lasix), it is crucial to monitor potassium levels closely. Furosemide is a loop diuretic that can lead to potassium loss, potentially causing hypokalemia. Monitoring potassium levels helps prevent adverse effects associated with low potassium, such as cardiac arrhythmias. While monitoring sodium, calcium, and chloride levels may also be important in certain situations, potassium is the most critical to monitor when administering furosemide.

5. Which order should the nurse question?

• A. The addition of a loop diuretic with digoxin.
• B. The addition of a beta blocker with digoxin.
• C. A digoxin dose of 0.125 mg per day.
• D. The addition of an ACE inhibitor with digoxin.

Correct answer: B

Rationale: The correct answer is B because adding a beta blocker to digoxin can potentiate the bradycardic effect of digoxin, leading to serious complications such as heart block. This combination requires caution as it can significantly slow down the heart rate. Choices A, C, and D are not the best options to question in this scenario. Loop diuretics are commonly used with digoxin, a digoxin dose of 0.125 mg per day is within the typical range, and ACE inhibitors are often prescribed alongside digoxin for managing heart conditions.

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