Nursing Elites

1. The healthcare provider is caring for a patient who is taking warfarin (Coumadin). Which laboratory value should the healthcare provider monitor closely?

• A. Platelet count.
• B. Prothrombin time (PT).
• C. Hemoglobin level.
• D. White blood cell count.

Correct answer: B

Rationale: Corrected Rationale: When caring for a patient on warfarin, monitoring prothrombin time (PT) is crucial. PT helps assess the blood's ability to clot properly, ensuring the patient maintains therapeutic anticoagulation levels while minimizing bleeding risks. Platelet count (Choice A) is important but not the most critical for warfarin therapy. Hemoglobin level (Choice C) and white blood cell count (Choice D) are not directly related to monitoring the effects of warfarin.

2. A 60-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?

• A. Hepatitis C
• B. Primary biliary cirrhosis
• C. Hemochromatosis
• D. Wilson's disease

Correct answer: B

Rationale: The symptoms of fatigue, pruritus, jaundice, and elevated bilirubin and alkaline phosphatase levels are classic features of primary biliary cirrhosis, an autoimmune liver disease. Hepatitis C typically presents with different symptoms and findings, such as specific viral markers. Hemochromatosis and Wilson's disease involve iron overload and copper accumulation, respectively, leading to distinct clinical and laboratory findings, which do not match the presentation described in this case.

3. A client is being discharged with a new prescription for enoxaparin (Lovenox). Which instruction should the nurse include?

• A. Administer the injection in your thigh.
• B. Do not expel the air bubble from the syringe before injection.
• C. Massage the injection site after administration.
• D. Alternate the injection site between the arms.

Correct answer: B

Rationale: The correct instruction for a client with a prescription for enoxaparin (Lovenox) is not to expel the air bubble from the syringe before injection. This ensures the full dose is delivered without affecting the medication's efficacy. Expelling the air bubble may lead to a loss of medication, resulting in suboptimal treatment. Therefore, it is crucial for the client to follow this instruction to receive the intended therapeutic effect of enoxaparin.

4. A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: B

Rationale: The combination of low TSH and high free T4 levels is characteristic of hyperthyroidism, not hypothyroidism. Hyperthyroidism is associated with symptoms such as fatigue, weight loss, and diarrhea, contrasting with the typical presentation of hypothyroidism. Therefore, in this case, the most likely diagnosis is hyperthyroidism.

5. A patient with coronary artery disease (CAD) is prescribed a statin medication. What should the nurse include in the patient education?

• A. Take the medication with food.
• B. Report any muscle pain or weakness.
• C. Increase intake of grapefruit juice.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: Patients prescribed statin medications should be educated to report any muscle pain or weakness to their healthcare provider promptly. Muscle pain or weakness could be a sign of rhabdomyolysis, a serious side effect associated with statin use that requires medical attention. Choices A, C, and D are incorrect. Taking statins with food or increasing grapefruit juice intake are not necessary recommendations. Avoiding foods high in potassium is also not directly related to statin use.

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