Nokea
The client has been prescribed warfarin (Coumadin) and is being educated about dietary restrictions. Which food should the client be advised to avoid or eat in consistent amounts?
- A. Bananas
- B. Spinach
- C. Oranges
- D. Yogurt
Correct Answer: B
Rationale: Spinach is high in vitamin K, which can interfere with the effectiveness of warfarin. It is important for clients taking warfarin to maintain consistent levels of vitamin K intake to ensure the medication works properly. Foods rich in vitamin K, such as spinach, can counteract the effects of warfarin, leading to potential complications. Therefore, clients on warfarin are advised to either avoid or consume vitamin K-rich foods, like spinach, in consistent amounts to maintain the medication's efficacy. Bananas, oranges, and yogurt are not high in vitamin K and do not significantly impact the effectiveness of warfarin, making them safe options for clients taking this medication.
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A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value should the nurse monitor to assess the effectiveness of the medication?
- A. Activated partial thromboplastin time (aPTT)
- B. Prothrombin time (PT) and international normalized ratio (INR)
- C. Platelet count
- D. Erythrocyte sedimentation rate (ESR)
Correct Answer: B
Rationale: Prothrombin time (PT) and international normalized ratio (INR) are the laboratory values used to monitor the effectiveness of warfarin therapy. These values help ensure that the client is within the therapeutic range for anticoagulation. PT measures the time it takes for blood to clot, while INR standardizes PT results to minimize variations between laboratories. Monitoring these values is crucial to prevent complications such as bleeding or clot formation. Activated partial thromboplastin time (aPTT) (Choice A) is more commonly used to monitor heparin therapy. Platelet count (Choice C) assesses the number of platelets in the blood and is not specific to warfarin therapy. Erythrocyte sedimentation rate (ESR) (Choice D) is a non-specific marker of inflammation and is not used to monitor the effectiveness of warfarin therapy.
What should be the nurse's priority action when a client diagnosed with angina pectoris complains of chest pain while taking a brisk walk?
- A. Administer nitroglycerin
- B. Have the client sit down
- C. Obtain an electrocardiogram
- D. Apply oxygen
Correct Answer: B
Rationale: The nurse's priority action when a client diagnosed with angina pectoris complains of chest pain while taking a brisk walk is to have the client sit down. Sitting down reduces the workload on the heart and may alleviate pain by improving oxygen supply. This action aims to reduce the strain on the heart and improve oxygen delivery to the myocardium, which can help relieve the symptoms of angina pectoris. Administering nitroglycerin could be the next step after having the client sit down if the pain persists. Obtaining an electrocardiogram and applying oxygen are not the immediate priority actions when dealing with angina pectoris symptoms.
Drugs that may cause anticholinergic effects include:
- A. Diphenhydramine
- B. Atenolol
- C. Lisinopril
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because diphenhydramine has strong anticholinergic effects (e.g., confusion, dry mouth), risky in the elderly, per Beers Criteria. Choice B is incorrect as atenolol (beta blocker) lacks anticholinergic action. Choice C is wrong because lisinopril (ACE inhibitor) doesn't affect cholinergic systems. Choice D is incorrect since only diphenhydramine applies.
Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
- A. Protein malnutrition
- B. Iron-deficiency anemia
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: A
Rationale: Choice A is correct because phase I metabolism, involving cytochrome P450 enzymes, relies on protein for enzyme synthesis; malnutrition impairs this, reducing metabolism. Choice B is incorrect as iron deficiency affects oxygen transport, not directly phase I processes. Choice C is wrong since only protein malnutrition, not iron deficiency, is directly relevant. Choice D is incorrect because protein malnutrition does impact metabolism.
The nurse is caring for a client diagnosed with heart failure who is taking digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse monitor for?
- A. Hypertension
- B. Bradycardia
- C. Hyperglycemia
- D. Insomnia
Correct Answer: B
Rationale: The correct answer is B: Bradycardia. Bradycardia is a common sign of digoxin toxicity, as digoxin can cause decreased heart rate. Therefore, monitoring the client for signs of bradycardia is crucial. Choices A, C, and D are incorrect. Hypertension is not typically associated with digoxin toxicity; instead, hypotension may occur. Hyperglycemia is not a common sign of digoxin toxicity. Insomnia is also not a typical sign of digoxin toxicity; instead, some patients may experience visual disturbances, confusion, or other neurological symptoms.