Nokea
The client has atrial fibrillation and is receiving warfarin (Coumadin) therapy. Which laboratory test should be monitored to evaluate the effectiveness of the warfarin therapy?
- A. Prothrombin time (PT) and international normalized ratio (INR)
- B. Activated partial thromboplastin time (aPTT)
- C. Complete blood count (CBC)
- D. Fibrinogen levels
Correct Answer: A
Rationale: Monitoring the Prothrombin time (PT) and international normalized ratio (INR) is crucial for assessing the effectiveness of warfarin therapy. These tests help determine the clotting ability of the blood and ensure that the client is within the desired therapeutic range to prevent clotting events or bleeding complications. Activated partial thromboplastin time (aPTT) (Choice B) is more commonly used to monitor heparin therapy, not warfarin. Complete blood count (CBC) (Choice C) and fibrinogen levels (Choice D) do not directly assess the effectiveness of warfarin therapy in the same way that PT and INR do.
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Michael calls the clinic to ask about taking fish oil supplements with his simvastatin prescription. The NP's response is:
- A. Avoid fish oil as it will increase your risk of bleeding.
- B. There are no known interactions; it is safe to take fish oil with simvastatin.
- C. Avoid fish oil as it will decrease the effectiveness of the simvastatin.
- D. Fish oil should only be taken with simvastatin if prescribed by your cardiologist.
Correct Answer: B
Rationale: Choice B is correct because fish oil (omega-3s) and simvastatin both lower triglycerides with no significant interactions; studies show they're safe together, enhancing lipid benefits. Choice A is incorrect as fish oil's bleeding risk is minimal and not amplified by simvastatin. Choice C is wrong because fish oil doesn't reduce simvastatin's efficacy—they're complementary. Choice D is incorrect since no prescription is needed for this safe combination.
Drugs that should be avoided in the elderly include:
- A. Acetaminophen
- B. Amitriptyline
- C. Amoxicillin
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because amitriptyline, a tricyclic antidepressant, is avoided in the elderly (per Beers Criteria) due to anticholinergic effects causing confusion, constipation, and falls. Choice A is incorrect as acetaminophen is safe. Choice C is wrong because amoxicillin is appropriate with dose adjustment. Choice D is incorrect since only amitriptyline fits.
Nurse practitioner prescriptive authority is regulated by:
- A. The National Council of State Boards of Nursing
- B. The U.S. Drug Enforcement Administration
- C. The State Board of Nursing for each state
- D. The State Board of Pharmacy
Correct Answer: C
Rationale: The correct answer is choice C, the State Board of Nursing for each state, because these boards establish the legal scope of practice for nurse practitioners, including prescriptive authority, which varies by state due to differing regulations. Choice A, the National Council of State Boards of Nursing, is incorrect as it provides guidelines and licensure standards but doesn't directly regulate state-specific authority. Choice B, the U.S. Drug Enforcement Administration, is wrong because it oversees controlled substances, not general prescribing rights. Choice D, the State Board of Pharmacy, is also incorrect since it governs pharmacists, not NPs, and has no jurisdiction over their prescriptive authority.
A client diagnosed with hypertension is prescribed atenolol (Tenormin). The nurse should monitor the client for which common side effect of this medication?
- A. Tachycardia
- B. Dry mouth
- C. Hypotension
- D. Increased appetite
Correct Answer: C
Rationale: Atenolol is a beta-blocker that works by lowering blood pressure. A common side effect of atenolol is hypotension, where blood pressure drops too low. Therefore, the nurse should monitor the client for signs and symptoms of hypotension to prevent any complications. Choices A, B, and D are incorrect because tachycardia (fast heart rate), dry mouth, and increased appetite are not common side effects of atenolol. Hypotension is the expected side effect due to the medication's mechanism of action.
An adolescent girl has decided to become a vegetarian. The primary care NP should counsel her about iron intake and considering a vitamin containing:
- A. zinc.
- B. vitamin A.
- C. vitamin C.
- D. potassium.
Correct Answer: A
Rationale: The correct answer is A because vegetarians often lack zinc, critical alongside iron. Choice B is incorrect (vitamin A not primary). Choice C is wrong (vitamin C aids iron, not primary). Choice D is inaccurate (potassium unrelated).