A nurse is discussing with a client who knows someone taking metoprolol for blood pressure management. The client inquires whether metoprolol would be suitable for her as well. Based on the client's medical record, which of the following should the nurse recognize as a contraindication to metoprolol?

Recently treated bilateral pneumonia

A concurrent prescription for tadalafil

Diet-controlled diabetes mellitus Type 2

A history of sinus bradycardia

Answer and Explanation

The Correct Answer is D

Choice A reason : Recently treated bilateral pneumonia is not a contraindication to metoprolol. Metoprolol is a beta-blocker used primarily for the management of hypertension and is not affected by a history of pneumonia.

Choice B reason : While tadalafil is known to interact with medications that lower blood pressure, it is not a direct contraindication to metoprolol. However, caution is advised when they are used concurrently due to the potential for additive blood pressure-lowering effects.

Choice C reason : Diabetes mellitus Type 2, especially when diet-controlled, is not a contraindication to metoprolol. Beta-blockers like metoprolol can mask hypoglycemic symptoms, so patients with diabetes should be monitored closely, but it does not preclude the use of the medication.

Choice D reason : A history of sinus bradycardia is a contraindication to metoprolol. Metoprolol can exacerbate bradycardia, leading to hemodynamic instability and is therefore contraindicated in patients with a history of significant bradycardia.

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Correct Answer is A

Explanation

Choice A reason : The therapeutic INR range for a patient on Warfarin, especially for conditions such as atrial fibrillation, venous thromboembolism, and for the prevention of thrombosis in patients with prosthetic heart valves, is typically 2.0-3.0. This range balances the risk of clotting with the risk of bleeding. An INR of 2.0-3.0 means that the blood is taking twice to three times as long as normal blood to clot, which is the desired effect of the medication in preventing harmful clots.

Choice B reason : An INR range of 4.0-5.0 is generally considered too high for most therapeutic purposes and increases the risk of bleeding complications. This range might be appropriate in very specific clinical situations, such as for patients with mechanical heart valves who may require a slightly higher INR, but it is not the standard therapeutic range.

Choice C reason : An INR range of 1.0-2.0 is below the therapeutic range for patients on Warfarin. This range would not provide sufficient anticoagulation and would leave the patient at risk for thrombotic events.

Choice D reason : An INR range of 3.0-4.9 is higher than the standard therapeutic range and could lead to an increased risk of bleeding. While some patients with mechanical heart valves in the mitral position may require an INR up to 3.5, an INR higher than this is usually not necessary and could be dangerous.

A. Hemoglobin (Hgb) : 16 g/dL B. Prothrombin Time (PT) : 45 seconds C. Activated Partial Thromboplastin Time (aPTT) : 36 seconds D. Platelets : 190,000/mm

Correct Answer is B

Explanation

Choice A reason : A hemoglobin (Hgb) level of 16 g/dL is within the normal range for adults, which typically falls between 13.8 to 17.2 g/dL for men and 12.1 to 15.1 g/dL for women. Therefore, this value does not warrant reporting to the provider as it does not indicate an immediate concern.

Choice B reason : A prothrombin time (PT) of 45 seconds is significantly higher than the normal range of 11 to 13.5 seconds for individuals not on anticoagulation therapy. For patients on warfarin, the target PT is usually 1.5 to 2 times the normal value, depending on the indication for therapy. However, a PT of 45 seconds suggests a high risk of bleeding and requires immediate medical attention.

Choice C reason : The activated partial thromboplastin time (aPTT) of 36 seconds is within the normal range of approximately 21 to 35 seconds⁸. This result indicates that the blood's intrinsic clotting pathway is functioning within expected parameters and does not need to be reported.

Choice D reason : A platelet count of 190,000/mm is within the normal range, which is typically 150,000 to 450,000 platelets/mm. This value is not concerning and does not need to be reported to the provider.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing the therapeutic International Normalized Ratio (INR) range for a patient receiving Warfarin. Which INR range below is therapeutic?

Correct Answer is A

Explanation

A nurse on a telemetry unit is reviewing the laboratory results for a client who has atrial fibrillation and is taking warfarin. Which of the following laboratory values should the nurse report to the provider?

Correct Answer is B

Explanation

A nurse is collecting data on a client who has bradycardia. Which of the following findings should the nurse expect?

A nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurse should recognize that which of the following statements by the client indicates a need for further teaching?

A nurse is reinforcing teaching with a client who has peripheral vascular disease. Which of the following instructions should the nurse include in the teaching?

A nurse is reinforcing teaching with a client who has hypertension and inquires if there is a herbal supplement that can be used to help lower blood pressure. The nurse should identify which of the following herbal supplements the client can use to help lower blood pressure :

A nurse is caring for a client who recently had surgery for the insertion of a permanent pacemaker. Which of the following prescriptions should the nurse question?

A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?

A nurse is preparing to administer digoxin to a client who has left-sided heart failure. Which of the following clinical manifestations should the nurse expect to see in this client? (Select all that apply.)