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 client with chronic kidney disease (CKD) is experiencing hyperkalemia. Which intervention should the nurse implement to address this condition?

• A. Administer calcium gluconate.
• B. Encourage a diet high in potassium.
• C. Provide potassium supplements.
• D. Restrict sodium intake.

Correct answer: A

Rationale: Administering calcium gluconate is the appropriate intervention for a client with hyperkalemia. Calcium gluconate helps stabilize the heart by counteracting the effects of high potassium levels and reducing the risk of cardiac complications in individuals with hyperkalemia. Choices B, C, and D are incorrect. Encouraging a diet high in potassium or providing potassium supplements would exacerbate hyperkalemia. Restricting sodium intake is not directly related to addressing hyperkalemia.

3. The client with newly diagnosed osteoporosis is being taught by the nurse about dietary modifications. Which instruction should the nurse include?

• A. Increase your intake of high-calcium foods.
• B. Limit your intake of vitamin D-rich foods.
• C. Avoid foods high in phosphorus.
• D. Increase your intake of high-sodium foods.

Correct answer: A

Rationale: Increasing the intake of high-calcium foods is essential for improving bone density and managing osteoporosis. Calcium is a key mineral necessary for bone health, and individuals with osteoporosis often need higher levels of calcium to help strengthen their bones and prevent further bone loss. Therefore, advising the client to increase their intake of high-calcium foods is the most appropriate dietary modification to support their bone health.

4. A client with chronic pain is prescribed a fentanyl (Duragesic) patch. Which instruction should the nurse provide to the client?

• A. Apply the patch to a clean, dry, and hairless area of the skin.
• B. Use a heating pad over the patch to enhance absorption.
• C. Change the patch daily to maintain effectiveness.
• D. Place the patch on the same site with each application.

Correct answer: A

Rationale: The correct instruction for applying a fentanyl (Duragesic) patch is to place it on a clean, dry, and hairless area of the skin. This ensures proper adhesion of the patch and optimal absorption of the medication. Using a heating pad over the patch is contraindicated as it can increase drug absorption and lead to overdose. Changing the patch daily is necessary for some medications, but fentanyl patches are usually changed every 72 hours to maintain a steady blood level of the medication. Placing the patch on the same site with each application can lead to skin irritation, uneven drug absorption, and should be avoided to allow the skin to recover between applications.

5. A patient with a diagnosis of deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the heparin therapy?

• A. Prothrombin time (PT)
• B. Partial thromboplastin time (PTT)
• C. Bleeding time
• D. Platelet count

Correct answer: B

Rationale: The correct answer is B: Partial thromboplastin time (PTT). Heparin affects the intrinsic pathway of the coagulation cascade, which is reflected by changes in the PTT. Monitoring the PTT helps ensure that the patient's blood is within the desired therapeutic range and prevents complications related to clotting or bleeding. Prothrombin time (PT) primarily assesses the extrinsic pathway and is not as sensitive to heparin therapy. Bleeding time and platelet count are not specific tests for monitoring the effectiveness of heparin therapy in DVT.

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