In checking the chart of an elderly female outpatient on anticoagulant therapy, the LPN/LVN notes that the patient's lab values are abnormal. The patient says she takes her medication as prescribed, so the nurse asks about her dietary intake
Which food might have an effect on anticoagulant therapy?
a.
Broccoli
b.
Eggplant
c.
Oranges
d.
Grapes
ANS: A
The patient should eat a normal, balanced diet but should avoid excessive amounts of foods high in vitamin K (broccoli, cabbage, green onions, dark leafy greens, beef liver, soybean oil).
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A patient develops ventricular tachycardia on the cardiac monitor. The patient says, "My heart is racing" as the nurse determines a rapid pulse is present. What is the nurse's priority intervention?
1. Call respiratory therapy to prepare a mechanical ventilator. 2. Draw blood for arterial blood gases. 3. Prepare for a change in intravenous fluid being administered. 4. Monitor the patient for loss of consciousness.
A nurse is teaching a nursing student about a specific acquired immunity system. Which statement by the student indicates a need for further teaching?
a. "Cell-mediated immunity and humoral immunity are both types of specific acquired immune responses." b. "Each exposure to an antigen causes a faster, more intense response." c. "Immune responses occur only after exposure to a foreign substance." d. "The skin is a factor in specific acquired immunity."
A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural "no matter what!" What is the nurse's best response?
a. "I'll make sure you get your epidural." b. "You may only have an epidural if your physician allows it." c. "You may only have an epidural if you are going to deliver vaginally." d. "The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth."
The nurse is assisting with care of a resident diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment findings does the nurse anticipate? (Select all that apply.)
a. Progressive weakness b. Pill-rolling tremor c. Ascending paralysis d. Hemiparesis e. Decreased coordination of extremities f. Bradykinesia