Nokea
The client on enoxaparin (Lovenox) is scheduled for surgery. What is the nurse's priority action?
- A. Hold the enoxaparin and notify the healthcare provider.
- B. Administer the enoxaparin as scheduled.
- C. Administer vitamin K before the surgery.
- D. Monitor the client's INR and proceed with surgery.
Correct Answer: A
Rationale: The correct answer is A: Hold the enoxaparin and notify the healthcare provider. Enoxaparin is an anticoagulant that increases the risk of bleeding during surgery. Holding it reduces this risk. Notifying the healthcare provider is crucial for further guidance. Administering enoxaparin (B) can lead to excessive bleeding. Administering vitamin K (C) is not indicated for enoxaparin therapy. Monitoring INR (D) is not appropriate for enoxaparin, which does not affect INR levels.
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Nurse's role in management of client with permanent pacemaker implant.
- A. Monitoring
- B. Education
- C. Both A and B
- D. None of the above
Correct Answer: C
Rationale: Nurses monitor device function and educate patients about care.
A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin, and lisinopril. To prevent the risk of digitalis toxicity with these drugs, it is most important that the nurse monitor the patient's
- A. HR
- B. BP
- C. Potassium levels
- D. GI function
Correct Answer: C
Rationale: Hypokalemia is one of the most common causes of digitalis toxicity. When a patient is receiving potassium losing diuretics, such as hydrochlorothiazide and furosemide, it is essential to monitor the potassium level.
What is a condition where the heart is unable to relax properly between beats, reducing its ability to fill with blood?
- A. Diastolic heart failure
- B. Systolic heart failure
- C. Hypertrophic cardiomyopathy
- D. Restrictive cardiomyopathy
Correct Answer: A
Rationale: The correct answer is A: Diastolic heart failure. In diastolic heart failure, the heart is unable to relax properly during the filling phase (diastole), leading to impaired filling of the ventricles. This results in decreased blood supply to the body. Systolic heart failure, on the other hand, is characterized by the heart's inability to contract effectively during the ejection phase (systole). Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle, affecting its function. Restrictive cardiomyopathy is characterized by stiffening of the heart muscle, impairing its ability to relax and fill properly, but it is different from diastolic heart failure.
Which term refers to the ability of the heart to initiate impulses repetitively and spontaneously?
- A. Contractility
- B. Excitability
- C. Automaticity
- D. Rhythmicity
Correct Answer: C
Rationale: The correct answer is C: Automaticity. Automaticity refers to the ability of the heart to generate electrical impulses spontaneously, without external stimulation. This allows the heart to initiate its own contractions independently of external influences. Contractility (A) refers to the ability of the heart muscle to contract in response to an electrical stimulus. Excitability (B) refers to the ability of cardiac cells to respond to an electrical stimulus. Rhythmicity (D) refers to the regularity of the heart's electrical impulses. Thus, C is the correct answer as it specifically addresses the heart's ability to generate impulses spontaneously.
Which disease is characterized by the damage to the alveoli in the lungs, leading to breathlessness?
- A. Emphysema
- B. Pulmonary fibrosis
- C. Lung cancer
- D. Lung abscess
Correct Answer: A
Rationale: The correct answer is A: Emphysema. This disease is characterized by the destruction of alveoli, leading to breathlessness. Emphysema is typically caused by smoking, resulting in the breakdown of lung tissue and reduced oxygen exchange. Pulmonary fibrosis (B) involves scarring of lung tissue, not alveolar damage. Lung cancer (C) is characterized by the growth of abnormal cells in the lung, not alveolar destruction. Lung abscess (D) is a localized infection in the lung, not related to alveolar damage causing breathlessness.