Nokea
A male client is scheduled to have angiography of his left leg. The nurse needs to include which of the following when preparing the client for this procedure?
- A. Validate that he is not allergic to iodine or shellfish.
- B. Instruct him to start active range of motion of his left leg immediately following the procedure.
- C. Inform him that he will not be able to eat or drink anything for 4 hours after the procedure.
- D. Inform him that vital signs will be taken every hour for 4 hours after the procedure.
Correct Answer: A
Rationale: Angiography, an invasive radiographic examination, involves the injection of a contrast solution (iodine) through a catheter that has been inserted into an artery. The client is kept on complete bed rest for 6-12 hours after the procedure. The extremity in which the catheter was inserted must be immobilized and kept straight during this time. The contrast dye, iodine, is nephrotoxic. The client must be instructed to drink a large quantity of fluids to assist the kidneys in excreting this contrast media. The major complication of this procedure is hemorrhage. Vital signs are assessed every 15 minutes initially for signs of bleeding.
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The client is receiving a continuous heparin infusion. Which laboratory value should the nurse monitor most closely?
- A. Platelet count
- B. Prothrombin time (PT)
- C. Activated partial thromboplastin time (aPTT)
- D. International normalized ratio (INR)
Correct Answer: C
Rationale: Heparin’s anticoagulant effect is monitored by aPTT, with a therapeutic range of 1.5–2.5 times the control value. Platelet count is monitored for heparin-induced thrombocytopenia, but PT and INR are for warfarin.
Chorioamnionitis is a maternal infection that is usually associated with:
- A. Prolonged rupture of membranes
- B. Postterm deliveries
- C. Maternal pyelonephritis
- D. Maternal dehydration
Correct Answer: A
Rationale: Chorioamnionitis is an inflammation of the chorion and amnion that is generally associated with premature or prolonged rupture of membranes.
To appropriately monitor therapy and client progress, the nurse should be aware that increased myocardial work and O2 demand will occur with which of the following?
- A. Positive inotropic therapy
- B. Negative chronotropic therapy
- C. Increase in balance of myocardial O2 supply and demand
- D. Afterload reduction therapy
Correct Answer: A
Rationale: Inotropic therapy will increase contractility, which will increase myocardial O2 demand. Decreased heart rate to the point of bradycardia will increase coronary artery filling time. This should be used cautiously because tachycardia may be a compensatory mechanism to increase cardiac output. The goal in the care of the MI client with angina is to maintain a balance between myocardial O2 supply and demand. Decrease in systemic vascular resistance by drug therapy, such as IV nitroglycerin or nitroprusside, or intra-aortic balloon pump therapy, would decrease myocardial work and O2 demand.
The nurse is planning care for the patient with celiac disease. In teaching about the diet, the nurse should instruct the patient to avoid which of the following for breakfast?
- A. Puffed wheat
- B. Banana
- C. Puffed rice
- D. Cornflakes
Correct Answer: A
Rationale: Celiac disease requires a gluten-free diet. Puffed wheat contains gluten and should be avoided. Bananas, puffed rice, and cornflakes (if certified gluten-free) are typically safe.
The nurse is preparing to check a client for Trousseau's sign. Which equipment should the nurse obtain?
- A. Tongue blade
- B. Blood pressure cuff
- C. Reflex hammer
- D. Stethoscope
Correct Answer: B
Rationale: Trousseau’s sign is elicited by inflating a blood pressure cuff on the arm to induce carpopedal spasm indicating hypocalcemia. The other equipment is not used for this assessment.