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A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed?
- A. Strict bed rest for 24 hours
- B. Bathroom privileges and self-care activities
- C. Unrestricted activities because the client is monitored
- D. Unsupervised hallway ambulation with distances less than 200 feet
Correct Answer: B
Rationale: After being transferred from the CCU to the general medical unit with cardiac monitoring, the client with MI is typically prescribed bathroom privileges and self-care activities. This allows for gradual recovery and mobility while still being closely monitored, promoting the client's overall well-being and independence.
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Prior to a dipyridamole thallium scan, what substance should the LPN/LVN ensure the client has not consumed?
- A. Caffeine
- B. Fatty meal
- C. Excess sugar
- D. Milk products
Correct Answer: A
Rationale: Caffeine should be avoided before a dipyridamole thallium scan as it can interfere with the test results. Caffeine is a stimulant that can affect the heart rate and may lead to inaccurate findings during the scan. Therefore, it is essential for the LPN/LVN to check and ensure that the client has not consumed caffeine prior to the procedure to obtain accurate diagnostic results.
The client with myocardial infarction should reduce intake of saturated fat and cholesterol. Which food items from the dietary menu would assist the nurse in helping the client comply with diet therapy?
- A. Cheeseburger, pan-fried potatoes, whole kernel corn, sherbet
- B. Pork chop, baked potato, cauliflower in cheese sauce, ice cream
- C. Baked haddock, steamed broccoli, herbed rice, sliced strawberries
- D. Spaghetti and sweet sausage in tomato sauce, vanilla pudding (with 4% milk)
Correct Answer: C
Rationale: Option C, which includes baked haddock, steamed broccoli, herbed rice, and sliced strawberries, is the most appropriate choice for a client with myocardial infarction looking to reduce saturated fat and cholesterol intake. This meal is low in saturated fats and cholesterol, making it a heart-healthy option that aligns with the dietary recommendations for such clients.
While preparing a client for a cardiac catheterization, the client expresses a preference to speak with their doctor rather than the nurse. Which response by the nurse should be therapeutic?
- A. Your doctor expects me to prepare you for this procedure.
- B. That's fine, if that's what you want. I'll call your health care provider.
- C. So you're saying that you want to talk to your health care provider?
- D. I'm concerned with the way you've dismissed me. I know what I am doing.
Correct Answer: C
Rationale: The therapeutic response by the nurse in this situation involves reflecting the client's feelings back to them, which demonstrates active listening and empathy. By restating the client's preference to talk to their doctor, the nurse acknowledges and validates the client's feelings, thereby fostering a positive therapeutic relationship and promoting open communication.
The client is receiving intravenous heparin for treatment of a pulmonary embolism. Which medication should the nurse ensure is readily available?
- A. Protamine sulfate
- B. Vitamin K
- C. Calcium gluconate
- D. Magnesium sulfate
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Before administering digoxin (Lanoxin) to a client diagnosed with heart failure, the nurse should perform which assessment?
- A. Check the blood pressure.
- B. Obtain an electrocardiogram (ECG).
- C. Assess the apical pulse.
- D. Review the latest electrolyte levels.
Correct Answer: C
Rationale: Assessing the apical pulse is crucial before administering digoxin because the medication can lead to bradycardia. Monitoring the apical pulse helps determine the heart rate, and digoxin is typically withheld if the pulse is below 60 beats per minute. This assessment is essential to prevent potential adverse effects associated with digoxin administration.