A client is receiving heparin therapy. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the therapy?
- A. PT
- B. aPTT
- C. INR
- D. Platelet count
Correct Answer: B
Rationale: The activated partial thromboplastin time (aPTT) is the laboratory value used to monitor the effectiveness of heparin therapy. The aPTT should be maintained at 1.5 to 2 times the normal level to ensure therapeutic anticoagulation. Monitoring aPTT helps healthcare providers adjust heparin doses to achieve the desired anticoagulant effects and prevent complications such as bleeding or clotting.
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A healthcare provider is reviewing the health care record of a client who is asking about conjugated equine estrogens. The healthcare provider should inform the client this medication is contraindicated in which of the following conditions?
- A. Atrophic vaginitis
- B. Dysfunctional uterine bleeding
- C. Osteoporosis
- D. Thrombophlebitis
Correct Answer: D
Rationale: Conjugated equine estrogens are contraindicated in individuals with a history of thrombophlebitis due to the increased risk of thrombotic events associated with estrogen use. Thrombophlebitis is a condition characterized by inflammation and blood clot formation in the veins, and estrogen therapy can exacerbate this condition, leading to serious complications such as deep vein thrombosis. Therefore, caution is advised when considering estrogen therapy in clients with a history of thrombophlebitis to prevent adverse outcomes.
A client in the emergency department has Benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority?
- A. Administer flumazenil.
- B. Identify the client's level of orientation.
- C. Infuse IV fluids.
- D. Prepare the client for gastric lavage.
Correct Answer: B
Rationale: In a situation where a client presents with Benzodiazepine toxicity, the priority action for the nurse is to assess the client. By identifying the client's level of orientation, the nurse can gather crucial information about the client's mental status, which is essential for determining the appropriate care and interventions needed. Administering flumazenil, infusing IV fluids, or preparing for gastric lavage may be necessary interventions but should follow a thorough assessment of the client's condition.
A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take?
- A. Obtain a blood specimen immediately prior to administering the next dose of medication.
- B. Verify that the client has been taking the medication for 24 hours before obtaining a blood specimen.
- C. Ask the client to provide a urine specimen after the next dose of medication.
- D. Administer the medication and obtain a blood specimen 30 minutes later.
Correct Answer: A
Rationale: To verify the trough levels of a medication accurately, the nurse should obtain a blood specimen immediately before administering the next dose of the medication. The trough level represents the lowest concentration of the medication in the bloodstream, typically right before the next dose is due. This timing ensures an accurate assessment of the drug's concentration in the body at its lowest point, aiding in determining the drug's effectiveness and potential toxicity levels.
When caring for a client receiving treatment with irinotecan, which of the following findings should the nurse monitor?
- A. Diarrhea
- B. Hypertension
- C. Ototoxicity
- D. Neutropenia
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client has a new prescription for a Nitroglycerin transdermal patch. Which of the following instructions should the nurse include?
- A. Apply the patch to a different site each day.
- B. Remove the patch at bedtime each day.
- C. Apply the patch over an area with little or no hair.
- D. Keep the patch on for 24 hours at a time.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.