Nokea
A male client is presenting with radiating chest pain. Which of the following would the nurse recognize as indicators that an acute myocardial infarction may be occurring?
- A. Positive troponin markers
- B. ST elevation on EKG on two contiguous leads
- C. Pain relieved with rest
- D. Diaphoresis
Correct Answer: B
Rationale: MI's hallmark ST elevation in contiguous leads flags acute infarction, showing transmural injury, a nurse's red alert for cath lab prep. Troponins rise later, confirming damage. Rest-relieved pain fits angina, not MI. Diaphoresis tags along but isn't diagnostic alone. EKG's immediacy nails this, driving urgent care in this chest pain crisis.
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When assignments are being made for clients with alterations related to gastrointestinal (GI) cancer, which client would be the most appropriate to delegate to an LPN/LVN?
- A. A client with severe anemia secondary to GI bleeding
- B. A client who needs enemas and antibiotics to control GI bacteria
- C. A client who needs preoperative teaching for bowel resection surgery
- D. A client who needs central line insertion for chemotherapy
Correct Answer: B
Rationale: Delegating in GI cancer care hinges on scope LPN/LVNs handle routine tasks like administering enemas and antibiotics, a straightforward intervention to curb bacteria, fitting their training under RN oversight. Severe anemia from bleeding demands RN assessment for stability or transfusion, beyond LPN scope. Preoperative teaching requires detailed education and evaluation, an RN's domain. Central line insertion involves advanced skills and risks, reserved for RNs or specialists. Enemas and antibiotics align with LPN/LVN capabilities, optimizing team roles while keeping complex care with RNs, a practical choice in managing GI cancer's multifaceted needs safely and efficiently.
Triglycerides are absorbed in the intestines after a meal. Question: After being absorbed by intestinal cells, triglycerides are transported in the blood circulation by which lipid particle?
- A. Chylomicron particle
- B. HDL particle
- C. IDL particle
- D. VLDL particle
Correct Answer: A
Rationale: Post-meal triglycerides ride chylomicrons gut to blood, not HDL, IDL, or VLDL's liver gig. Nurses track this, a chronic fat ferry.
A person is 178 cm high and weighs 89 kg. What is his BMI?
- A. 26
- B. 28
- C. 31
- D. 34
Correct Answer: B
Rationale: BMI's weight over height squared 89 kg ÷ (1.78 m × 1.78 m) ≈ 28. Height in meters, simple math, lands between 25 and 30, overweight, not obese. Nurses crunch this daily, a chronic weight watch pegging 28 spot-on.
The nursing considerations that should be applied when assisting diabetics in management of their condition does not include:
- A. BGL monitoring, medications and compliance with treatment and medication
- B. Recognition and early intervention of potential complications
- C. Skin and foot care, including pressure area care when hospitalised
- D. Minimising exercise to prevent fatigue and foot ulcers
Correct Answer: D
Rationale: Diabetes nursing BGLs, meds, complication spots, skin/foot TLC all key. No exercise? Flops movement cuts sugar, boosts health, not ulcers. Nurses nix this, a chronic active push.
The nurse assesses a client and documents the following findings: edema 2+ bilateral ankles, brown pigmentation of lower extremity skin, aching pain of lower extremities when standing that resolves with elevation, and 2+ pedal pulses. What condition does the client likely have?
- A. Deep vein thrombosis
- B. Raynaud's disease
- C. Venous insufficiency
- D. Peripheral arterial disease
Correct Answer: C
Rationale: Venous insufficiency pools blood 2+ edema, brown pigmentation from hemosiderin, aching relieved by elevation, and decent pulses fit, as veins fail while arteries hold. DVT clots acutely, often unilateral. Raynaud's spasms, not pigments. PAD dims pulses, pains with walking. Nurses peg this chronic venous flop, suggesting hose or elevation, a textbook stasis tale.