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A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which laboratory value indicates a therapeutic effect of the medication?
- A. INR of 2.5.
- B. PTT of 45 seconds.
- C. Hemoglobin of 12 g/dL.
- D. Platelet count of 150,000/mm³.
Correct Answer: A
Rationale: The correct answer is A: INR of 2.5. INR (International Normalized Ratio) is used to monitor the effectiveness of warfarin therapy. A target INR range for DVT treatment is typically 2.0-3.0. An INR of 2.5 indicates that the client's blood is clotting within the desired therapeutic range, preventing excessive clotting while avoiding excessive bleeding.
B: PTT measures the effectiveness of heparin, not warfarin.
C: Hemoglobin level and D: Platelet count are not specific indicators of warfarin's therapeutic effect on clotting factors.
In summary, the correct answer A is the most relevant laboratory value for monitoring the therapeutic effect of warfarin in a client with DVT.
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A 70-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Gallstones
- B. Hepatitis
- C. Pancreatic cancer
- D. Primary biliary cirrhosis
Correct Answer: C
Rationale: The most likely diagnosis in this case is pancreatic cancer (Choice C) based on the constellation of symptoms including weight loss, jaundice, palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels. These findings are indicative of a pancreatic head mass causing obstruction of the common bile duct, leading to jaundice and elevated liver enzymes. Gallstones (Choice A) typically present with colicky pain, not a palpable mass. Hepatitis (Choice B) would present with different liver enzyme patterns and usually lacks a palpable mass. Primary biliary cirrhosis (Choice D) typically presents with pruritus and fatigue, not a palpable mass and jaundice.
A client with a diagnosis of rheumatoid arthritis is experiencing severe pain. Which medication is likely to be prescribed?
- A. Acetaminophen (Tylenol)
- B. Ibuprofen (Advil)
- C. Methotrexate (Rheumatrex)
- D. Prednisone (Deltasone)
Correct Answer: C
Rationale: The correct answer is C: Methotrexate (Rheumatrex). Methotrexate is a disease-modifying antirheumatic drug commonly prescribed for managing rheumatoid arthritis. It helps reduce inflammation and pain by targeting the immune system's overactivity. Acetaminophen (A) is a mild pain reliever and does not treat the underlying inflammation in rheumatoid arthritis. Ibuprofen (B) is a nonsteroidal anti-inflammatory drug (NSAID) that can help with pain and inflammation but is not as effective in managing rheumatoid arthritis as methotrexate. Prednisone (D) is a corticosteroid that can provide quick relief from inflammation and pain, but it is typically used for short-term management due to its potential side effects.
A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?
- A. Two to three soft bowel movements daily
- B. Significant increase in appetite and food intake
- C. Absence of nausea and vomiting
- D. Absence of blood or mucus in stool
Correct Answer: A
Rationale: The correct answer is A: Two to three soft bowel movements daily. Lactulose is a laxative commonly used to manage hepatic encephalopathy by reducing ammonia levels through promoting bowel movements. The desired outcome of this medication is to prevent the buildup of ammonia in the bloodstream, which can exacerbate hepatic encephalopathy. Soft bowel movements indicate that the medication is effectively promoting bowel motility and reducing ammonia levels. Choices B, C, and D are incorrect as lactulose is not directly associated with increasing appetite, resolving nausea and vomiting, or eliminating blood or mucus in the stool in this context.
A 30-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?
- A. Type 1 diabetes mellitus
- B. Type 2 diabetes mellitus
- C. Diabetes insipidus
- D. Hyperthyroidism
Correct Answer: A
Rationale: Step 1: Symptoms of fatigue, polyuria, polydipsia point to diabetes.
Step 2: Hyperglycemia and ketonuria suggest uncontrolled diabetes.
Step 3: Onset in a 30-year-old woman is more common in Type 1 diabetes.
Step 4: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells leading to insulin deficiency.
Step 5: Treatment for Type 1 diabetes involves insulin therapy.
Summary:
- Choice B (Type 2 diabetes) is less likely due to the acute presentation and ketonuria.
- Choice C (Diabetes insipidus) does not involve hyperglycemia or ketonuria.
- Choice D (Hyperthyroidism) does not typically present with hyperglycemia and ketonuria.
The preceptor is orienting a new graduate nurse to the critical care unit. The preceptor asks the new graduate to state symptoms that most likely indicate the beginning of a shock state in a critically ill client. What findings should the new graduate nurse identify?
- A. Warm skin, hypertension, and constricted pupils.
- B. Bradycardia, hypotension, and respiratory acidosis.
- C. Mottled skin, tachypnea, and hyperactive bowel sounds.
- D. Tachycardia, mental status change, and low urine output.
Correct Answer: D
Rationale: The correct answer is D: Tachycardia, mental status change, and low urine output. In the early stages of shock, the body compensates by increasing heart rate (tachycardia) to maintain perfusion. Mental status change can indicate decreased cerebral perfusion. Low urine output is a sign of decreased renal perfusion.
A: Warm skin, hypertension, and constricted pupils are not indicative of shock. In shock, skin becomes cool and clammy, blood pressure drops, and pupils dilate.
B: Bradycardia, hypotension, and respiratory acidosis are not early signs of shock. Bradycardia and hypotension occur in the late stages of shock. Respiratory acidosis is a complication of shock, not an early symptom.
C: Mottled skin, tachypnea, and hyperactive bowel sounds are signs of shock but not early indicators. Mottled skin appears in the late stages of shock, tach