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Following a THR, the client asks the nurse, “Why am I receiving enoxaparin? With my last hip surgery, I was given a heparin injection.†What is the nurse's best response?
- A. Enoxaparin is less expensive for you and much easier to administer than the heparin.
- B. There is less risk of bleeding with enoxaparin, and it doesn't affect your laboratory results.
- C. Enoxaparin is a low-molecular-weight heparin that lasts twice as long as regular heparin.
- D. Enoxaparin can be administered orally, whereas heparin is administered only by injection.
Correct Answer: C
Rationale: A: The cost of enoxaparin is more than twice the cost of the equivalent dose of heparin per injection. Both are available in prefilled syringes for subcutaneous injection. B: Both enoxaparin and heparin increase aPTT, which affects clotting. C: Because enoxaparin is more specific in inhibiting active factor X, the response is more stable, and the effect is two to four times longer than that of heparin. D: Enoxaparin is only administered subcutaneously. Heparin can be administered both subcutaneously and intravenously.
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One day postoperative, the client complains of dyspnea, and his respiratory rate (RR) is 35, slightly labored, and there are no breath sounds in the lower-right base. The nurse should suspect:
- A. Cor pulmonale
- B. Atelectasis
- C. Pulmonary embolus
- D. Cardiac tamponade
Correct Answer: B
Rationale: No breath sounds in the lower-right base postoperative suggest atelectasis, a lung collapse common after surgery, causing dyspnea and tachypnea.
The LPN is caring for a client newly diagnosed with HIV. Which statement made by the client regarding antiretroviral therapy (ART) would require correction from the nurse?
- A. If I start ART and use condoms, I'm less likely to transmit HIV to my partner.
- B. I can still use ART even though I am Hepatitis C positive.
- C. I will need to be on ART indefinitely.
- D. I know I will need to come back for blood draws so that I can begin ART when my CD4 count is over 1,000 cells/mm3.
Correct Answer: D
Rationale: The World Health Organization (WHO) recommends making treatment for those with a CD4 count of ≤ 350 cells/mm3 a priority, as early intervention can help delay disease progression. Studies have shown that ART can reduce HIV transmission to sexual partners by up to 96%. Conditions such as pregnancy and Hepatitis B and C increase the need to initiate therapy sooner and are in no way contraindicated. ART does not cure HIV, but to maintain viral suppression, it should be continued indefinitely.
The client is being discharged with a prescription for an inhaled glucocorticoid for asthma. Which of the following statements indicates additional education is needed prior to discharge?
- A. I will hold my breath for 10 seconds after each puff.
- B. I will wait five minutes after taking this medication and then gargle water.
- C. I will wait at least one minute in between each puff.
- D. I will take this medication daily even if I am not having symptoms.
Correct Answer: B
Rationale: The client should gargle and spit water immediately after taking an inhaled glucocorticoid to remove residue of the medication, which can lead to thrush.
The client with MS is prescribed baclofen. Which information is most important for the nurse to evaluate when caring for this client?
- A. Serum baclofen levels
- B. Muscle rigidity and pain
- C. Intake and urine output
- D. Daily weight pattern
Correct Answer: B
Rationale: A: There is no serum baclofen level. B: Baclofen (Lioresal) is used primarily to treat spasticity in MS and spinal cord injuries. The nurse should assess for muscle rigidity, movement, and pain to evaluate medication effectiveness. C: Although baclofen can cause urinary urgency, this is not the most important information. D: Baclofen use is not associated with weight.
The LPN is about to give 100 mg Lopressor (metoprolol) to a client. Before administering the drug, he takes the patient's vitals, which are as follows: Pulse: 58, Blood Pressure: 90/62, Respirations: 18/minute. What action should the LPN take?
- A. Give the client half the prescribed dose and report the findings to the RN on duty.
- B. Give the client double the dose and report the findings to the RN on duty.
- C. Administer the drug and report the findings to the RN on duty.
- D. Hold the drug and report the findings to the RN on duty.
Correct Answer: D
Rationale: Lopressor is given to treat hypertension, and a pulse of 58 and a blood pressure of 90/62 are considered low. To prevent the client from bottoming out, the drug should be held and the findings reported to the RN, who should consult with the attending physician. LPNs should never adjust client dosing, as that is outside of their scope of practice.