Nokea
The client on enoxaparin (Lovenox) is scheduled for surgery. What is the nurse's priority action?
- A. Hold the enoxaparin and notify the healthcare provider.
- B. Administer the enoxaparin as scheduled.
- C. Administer vitamin K before the surgery.
- D. Monitor the client's INR and proceed with surgery.
Correct Answer: A
Rationale: The correct answer is A: Hold the enoxaparin and notify the healthcare provider. Enoxaparin is an anticoagulant that increases the risk of bleeding during surgery. Holding it reduces this risk. Notifying the healthcare provider is crucial for further guidance. Administering enoxaparin (B) can lead to excessive bleeding. Administering vitamin K (C) is not indicated for enoxaparin therapy. Monitoring INR (D) is not appropriate for enoxaparin, which does not affect INR levels.
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What is a device that delivers a fine spray of medication into the airways?
- A. Nebulizer
- B. Inhaler
- C. Oxygen concentrator
- D. Peak flow meter
Correct Answer: A
Rationale: The correct answer is A: Nebulizer. A nebulizer is a device that delivers medication in the form of a fine spray into the airways, making it easier for the patient to inhale the medication and reach the lungs. It is commonly used for treating respiratory conditions such as asthma and COPD. Inhalers (B) deliver medication in a different format, through a measured dose of medication in aerosol form. Oxygen concentrators (C) provide supplemental oxygen and do not deliver medication. Peak flow meters (D) are used to measure the peak expiratory flow rate and are not used to deliver medication.
Which assessment data collected from a client with chronic congestive heart failure would indicate precipitating causes?
- A. Subnormal body temp; Obesity; metabolic acidosis
- B. Peripheral hypotension, asthenia, high altitude
- C. Hyperthyroidism, bronchitis, overexertion
- D. Dry cough, orthopnea, bradycardia
Correct Answer: C
Rationale: These factors strain the heart.
What is a chronic condition where the airways in the lungs become damaged and widened, leading to mucus buildup and frequent infections?
- A. Bronchiectasis
- B. Chronic bronchitis
- C. Pneumoconiosis
- D. Asthma
Correct Answer: A
Rationale: The correct answer is A: Bronchiectasis. This condition involves permanent widening and damage to the airways, leading to mucus accumulation and recurrent infections. Chronic bronchitis (B) primarily involves inflammation of the bronchial tubes without permanent widening. Pneumoconiosis (C) is a group of lung diseases caused by inhaling mineral dust, not directly related to airway damage. Asthma (D) is characterized by reversible airway constriction and inflammation, not permanent widening like in bronchiectasis.
Two weeks later, Mr. Cook returns with normal blood pressure readings. Your evaluation of this situation would be
- A. since his blood pressure is normal, he no longer needs medication
- B. since his blood pressure recordings are normal, he no longer needs to maintain his prescribed diet
- C. his medication needs to be adjusted
- D. the combination of weight loss and medication is effective
Correct Answer: D
Rationale: Weight loss and medication contribute to effective blood pressure control.
The healthcare provider is monitoring a client on an ACE inhibitor. What lab value is most important to monitor?
- A. Potassium
- B. Sodium
- C. Creatinine
- D. Calcium
Correct Answer: A
Rationale: The correct answer is A: Potassium. ACE inhibitors can cause hyperkalemia, so monitoring potassium levels is crucial to prevent potential life-threatening complications. High potassium levels can lead to cardiac arrhythmias. Sodium levels are not typically affected by ACE inhibitors. Creatinine is important to monitor for kidney function but not specific to ACE inhibitors. Calcium levels are not directly affected by ACE inhibitors.