You are writing a care plan for a patient who is taking anticoagulant.
What would be an appropriate nursing diagnosis?

Maintain narcan on standby.

Notify the healthcare provider of any patient receiving this drug.

Evaluate patient for PT for 2.5.

Establish safety precautions.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Maintaining narcan (naloxone) on standby is not directly related to anticoagulant therapy. Narcan is used to reverse opioid overdoses, not to manage the effects of anticoagulants.

Choice B rationale

Notifying the healthcare provider of any patient receiving this drug is a general action but not an appropriate nursing diagnosis. Nursing diagnoses focus on identifying specific patient needs and planning care to address those needs.

Choice C rationale

Evaluating the patient for PT (prothrombin time) for 2.5 is an action, not a nursing diagnosis. Nursing diagnoses identify patient needs and risks, guiding the planning and implementation of care.

Choice D rationale

Establishing safety precautions is an appropriate nursing diagnosis for a patient on anticoagulant therapy. Anticoagulants increase the risk of bleeding, so ensuring patient safety and preventing injury is crucial to minimize this risk. .

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Correct Answer is D

Explanation

Choice A rationale

While maintaining patient confidentiality is crucial, it does not address the immediate medical needs of the patient with chronic renal failure. The primary concern should be addressing the health implications of their condition and ensuring proper care coordination.

Choice B rationale

Administering medications ordered immediately is essential, but it is not the first priority without knowing the patient's current status and medical history. The nurse needs to ensure that the medications prescribed are appropriate for a patient with chronic renal failure.

Choice C rationale

Providing teaching about chronic renal failure is important for long-term management but is not the first priority upon admission. Immediate medical needs and communication with the care team take precedence in this acute care setting.

Choice D rationale

Calling the admitting physician immediately is the first priority. The primary care provider needs to be aware of the patient's diagnosis of chronic renal failure to adjust treatment plans accordingly. Immediate communication ensures that all healthcare professionals are on the same page regarding the patient's care. .

A. Unstable. B. Ischemic. C. Stable angina. D. Prinzmetal.

Correct Answer is C

Explanation

Choice A rationale

Unstable angina is characterized by sudden, severe chest pain that occurs at rest or with minimal exertion and is not relieved by nitroglycerin. It represents an imminent risk of myocardial infarction.

Choice B rationale

Ischemic heart disease can cause various types of angina, including stable, unstable, and Prinzmetal’s angina. The term “ischemic” refers to a lack of blood flow to the heart muscle, but this choice is too broad.

Choice C rationale

Stable angina occurs when there is an imbalance between myocardial oxygen supply and demand, typically during physical exertion or emotional stress. It is characterized by predictable chest pain that is relieved by rest or nitroglycerin.

Choice D rationale

Prinzmetal’s angina, also known as variant angina, is caused by a spasm in the coronary arteries, which leads to a temporary reduction in blood flow. It can occur at rest and is not necessarily related to the imbalance of myocardial supply and demand.

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You are writing a care plan for a patient who is taking anticoagulant.What would be an appropriate nursing diagnosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse admits a patient to the unit and learns the patient has recently been diagnosed with chronic renal failure but has not informed the primary care provider of this diagnosis.What is the nurse’s first priority?

Correct Answer is D

Explanation

Ask the nurse to explain the type of angina he is experiencing.The nurse explains the pain is due to the imbalance of myocardial supply.

Correct Answer is C

Explanation

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You are writing a care plan for a patient who is taking anticoagulant.
What would be an appropriate nursing diagnosis?