A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?

Monitoring the client for increased bruising.

Assessing for signs and symptoms of infection.

Assessing the client’s level of consciousness.

Monitoring the client’s electrolyte levels.

Answer and Explanation

The Correct Answer is A

This is because levothyroxine can increase the anticoagulant effect of oral anticoagulants and increase the risk of bleeding. The nurse should check the client’s prothrombin time and international normalized ratio (INR) regularly and report any abnormal values to the prescriber.

Choice B is wrong because hypothyroidism does not increase the risk of infection.

Choice C is wrong because hypothyroidism does not affect the level of consciousness unless it is severe and causes myxedema coma.

Choice D is wrong because hypothyroidism does not cause electrolyte imbalances.

Normal ranges for prothrombin time are 11 to 13.5 seconds and for INR are 0.8 to 1.22.

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Correct Answer is A

Explanation

The nurse should ask this question because the client is taking a chemical stimulant laxative, which can cause dehydration and electrolyte imbalance, especially in combination with medications for heart failure and osteoarthritis that may also affect fluid and electrolyte balance. The nurse should assess the client’s hydration status and risk of hypovolemia or hypotension.

Choice B. Timing of medication administration is wrong because it is not the priority question in this situation.

The nurse should ask this question later to determine if the client is taking the medications as prescribed and if there are any drug interactions or adverse effects.

Choice C. Previous effectiveness of laxatives is wrong because it is not relevant to the client’s current condition.

The nurse should ask this question later to evaluate the client’s bowel habits and history of constipation.

Choice D. The amount of fiber intake is wrong because it is not the priority question in this situation.

The nurse should ask this question later to educate the client about dietary measures to prevent constipation and promote bowel health.

A. A client being treated for a traumatic brain injury. B. A client with a history of ischemic heart disease. C. A pediatric client. D. A client with type 2 diabetes.

Correct Answer is A

Explanation

This is because phenothiazines are contraindicated in patients with suspected or established subcortical brain damage. Phenothiazines can cause central nervous system effects such as drowsiness, dizziness, and extrapyramidal symptoms that may worsen the condition of a client with a brain injury.

Choice B is wrong because phenothiazines are not contraindicated in clients with ischemic heart disease.

However, they should be used with caution as they can cause hypotension and cardiac arrhythmias.

Choice C is wrong because phenothiazines are not contraindicated in pediatric clients.

However, they should be used with caution as they can cause sedation, anticholinergic effects, and paradoxical excitement.

Choice D is wrong because phenothiazines are not contraindicated in clients with type 2 diabetes.

However, they should be used with caution as they can cause hyperglycemia and alter the effects of antidiabetic drugs.

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A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine. What assessment should the nurse prioritize?

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Naxlex Comprehensive Predictor Exams

A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, “I’m just not feeling right.” What is the priority question the nurse should ask this client?

Correct Answer is A

Explanation

For which client would the use of a phenothiazine most likely be contraindicated?

Correct Answer is A

Explanation

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A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?