Nokea
Heparin sodium is prescribed for the client. The nurse expects that the healthcare provider will prescribe which of the following to monitor for a therapeutic effect of the medication?
- A. Hematocrit level
- B. Hemoglobin level
- C. Prothrombin time (PT)
- D. Activated partial thromboplastin time (aPTT)
Correct Answer: D
Rationale: The activated partial thromboplastin time (aPTT) is used to monitor the therapeutic effect of heparin sodium. Heparin affects the intrinsic pathway of coagulation, and monitoring aPTT helps ensure the medication is within the therapeutic range to prevent clot formation. Hematocrit and hemoglobin levels assess red blood cell concentrations, while prothrombin time (PT) is used to monitor the therapeutic effect of warfarin sodium, a different anticoagulant that affects the extrinsic pathway of coagulation.
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A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to:
- A. Count the radial and carotid pulses every morning.
- B. Check the blood pressure every morning and evening.
- C. Stop taking the medication if the pulse is higher than 100 beats per minute.
- D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.
Correct Answer: D
Rationale: When taking digoxin, monitoring the pulse rate is essential due to its potential effects on heart rate. Digoxin can lead to bradycardia, where the pulse rate drops significantly. Withholding the medication and promptly contacting the healthcare provider if the pulse falls below 60 beats per minute is crucial to prevent severe complications and ensure appropriate management.
A client is receiving intravenous gentamicin (Garamycin). Which of the following findings should prompt the nurse to notify the healthcare provider immediately?
- A. Nausea
- B. Hearing loss
- C. Headache
- D. Diarrhea
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client is receiving intravenous heparin for a deep vein thrombosis. The healthcare provider should monitor the client for which of the following potential complications?
- A. Hypertension
- B. Tachycardia
- C. Bleeding
- D. Hyperkalemia
Correct Answer: C
Rationale: Heparin is an anticoagulant, so the primary potential complication is bleeding. The healthcare provider should monitor the client for signs of bleeding, such as bruising, hematuria, and gastrointestinal bleeding. Hypertension, tachycardia, and hyperkalemia are not direct complications of heparin therapy.
A client is prescribed nitroglycerin (Nitro-Dur) transdermal patch for angina. Which instruction should the nurse include in the client's teaching plan?
- A. Apply the patch to a hairless area of skin.
- B. Leave the patch on for 24 hours.
- C. Apply the patch at the same time each day.
- D. You can keep the patch on while taking a shower.
Correct Answer: C
Rationale: The nurse should instruct the client to apply the nitroglycerin (Nitro-Dur) transdermal patch at the same time each day to ensure consistent blood levels. It is essential to apply the patch to a hairless area of the skin for proper absorption. The patch can generally be left on during a shower. The patch is usually worn for 12-14 hours to allow for a nitrate-free period, which helps reduce tolerance to the medication.
The clinic nurse is reviewing a teaching plan for a client receiving antineoplastic medication. When implementing the plan, the nurse should advise the client:
- A. To take aspirin (acetylsalicylic acid) as needed for a headache
- B. To avoid drinking beverages containing alcohol
- C. To consult with healthcare providers (HCPs) before receiving immunizations
- D. That it is necessary to consult HCPs before receiving a flu vaccine at the local health fair
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.