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

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.

A. “I will take this medication anytime I start to cough.”. B. “This medication may make me anxious and nervous.”. C. “This medication can cause drowsiness, so I will avoid driving after taking it.”. D. “I might get diarrhea, so I’ll call my provider if that happens.”.

Correct Answer is C

Explanation

This statement indicates that the patient understands the common side effect of codeine and how to prevent accidents while taking it.

Choice A is wrong because the patient should not take the medication anytime he starts to cough, but only as prescribed by the doctor.

Taking too much codeine can lead to overdose, addiction, or respiratory depression.

Choice B is wrong because this medication may not make the patient anxious and nervous, but rather sedated and relaxed.

Anxiety and nervousness are more likely to occur with decongestants, which are stimulants.

Choice D is wrong because diarrhea is not a common side effect of codeine.

In fact, codeine may cause constipation, so the patient should increase fluid and fiber intake while taking it.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

Correct Answer is A

Explanation

What statement by a client who is to take an antitussive with codeine indicates that the nurse’s teaching has been effective?

Correct Answer is C

Explanation

The nurse administers metoclopramide to the client with what condition?

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The nurse is providing client teaching regarding the administration of levothyroxine. What is the nurse’s priority teaching point?

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?