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A client who is receiving heparin therapy has an activated partial thromboplastin time (aPTT) of 90 seconds. What action should the nurse take?
- A. Increase the heparin infusion rate.
- B. Notify the healthcare provider.
- C. Apply pressure to the injection site.
- D. Administer protamine sulfate.
Correct Answer: B
Rationale: The correct answer is B: Notify the healthcare provider. A prolonged aPTT of 90 seconds indicates the client is at risk for bleeding due to excessive anticoagulation from heparin therapy. The nurse should notify the healthcare provider immediately to adjust the dosage or consider discontinuing heparin to prevent bleeding complications. Increasing the heparin infusion rate (A) would worsen the risk of bleeding. Applying pressure to the injection site (C) is not appropriate in this situation. Administering protamine sulfate (D) is the antidote for heparin overdose, but it is not the first action to take in this scenario.
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A client with a history of gout is experiencing an acute attack. Which medication should the nurse expect the healthcare provider to prescribe?
- A. Aspirin.
- B. Allopurinol (Zyloprim).
- C. Colchicine.
- D. Probenecid (Benemid).
Correct Answer: C
Rationale: The correct answer is C: Colchicine. Colchicine is used to treat acute gout attacks by reducing inflammation and pain. It works by decreasing the inflammatory response to urate crystals in the joints. Aspirin (choice A) is not recommended for gout treatment as it can worsen symptoms. Allopurinol (choice B) and Probenecid (choice D) are used for long-term management of gout by reducing uric acid levels and preventing future attacks, not for acute attacks. Colchicine is the appropriate choice for treating the client's acute gout symptoms.
A client with newly diagnosed hypertension is prescribed enalapril (Vasotec). Which instruction should the nurse provide to the client?
- A. Increase your intake of potassium-rich foods.
- B. Report any persistent cough to your healthcare provider.
- C. Take the medication with a full meal.
- D. Avoid grapefruit juice while taking this medication.
Correct Answer: B
Rationale: The correct answer is B: Report any persistent cough to your healthcare provider. Enalapril is an ACE inhibitor that can cause a dry, persistent cough as a side effect. This cough can be a sign of a serious condition called angioedema. Therefore, it is crucial for the client to report any cough to their healthcare provider promptly to assess and manage it.
Incorrect choices:
A: Increasing intake of potassium-rich foods is not necessary when taking enalapril, as it does not typically cause potassium imbalances.
C: Enalapril can be taken with or without food, so taking it with a full meal is not a specific instruction.
D: Avoiding grapefruit juice is typically recommended for medications metabolized by the CYP3A4 enzyme, which enalapril is not.
A client who participates in a health maintenance organization (HMO) needs a bone marrow transplant for the treatment of breast cancer. The client tells the nurse that she is concerned that her HMO may deny her claim. What action by the nurse best addresses the client's need at this time?
- A. Have the client's healthcare provider write a letter to the HMO explaining the need for the transplant.
- B. Help the client place a call to the HMO to seek information about limitations of coverage.
- C. Encourage the client to contact a lawyer to file a lawsuit against the HMO if necessary.
- D. Have the social worker contact the state board of insurance to register a complaint against the HMO.
Correct Answer: B
Rationale: The correct answer is B: Help the client place a call to the HMO to seek information about limitations of coverage. This is the best action because it directly addresses the client's concern by clarifying the coverage for the bone marrow transplant. By contacting the HMO, the client can get accurate information on whether the transplant is covered and what steps need to be taken for approval. This empowers the client to make informed decisions regarding their healthcare.
Choice A is incorrect because having the healthcare provider write a letter may not directly address the client's concerns about coverage. Choice C is incorrect as contacting a lawyer should be a last resort after exploring other options. Choice D is incorrect as involving the state board of insurance is not necessary at this stage and may escalate the situation unnecessarily.
A client with hypothyroidism is prescribed levothyroxine (Synthroid). Which instruction should the nurse provide?
- A. Take the medication with a meal.
- B. Take the medication at bedtime.
- C. Take the medication on an empty stomach.
- D. Take the medication with an antacid.
Correct Answer: C
Rationale: The correct answer is C: Take the medication on an empty stomach. Levothyroxine should be taken on an empty stomach in the morning, at least 30 minutes before eating, to ensure optimal absorption. Food can interfere with the absorption of levothyroxine, reducing its effectiveness. Taking it with a meal (option A) or at bedtime (option B) may lead to decreased absorption. Taking it with an antacid (option D) can also interfere with absorption. Therefore, the best instruction is to take the medication on an empty stomach to maximize its therapeutic effects.
The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?
- A. Hemoglobin level of 12 g/dL.
- B. Platelet count of 150,000/mm3.
- C. White blood cell count of 2,000/mm3.
- D. Serum creatinine level of 1.0 mg/dL.
Correct Answer: C
Rationale: The correct answer is C: White blood cell count of 2,000/mm3. A low white blood cell count indicates leukopenia, which increases the risk of infection in clients receiving chemotherapy. Hemoglobin level (choice A) and platelet count (choice B) are not directly related to infection risk. Serum creatinine level (choice D) is related to kidney function, not infection risk. In summary, a low white blood cell count is the most critical indicator for infection risk in clients undergoing chemotherapy.