Nokea
The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina. Priority goals for the client immediately after PTCA should include:
- A. Minimizing dyspnea.
- B. Maintaining adequate blood pressure control.
- C. Decreasing myocardial contractility.
- D. Preventing fluid volume deficit.
Correct Answer: B
Rationale: Maintaining adequate blood pressure post-PTCA ensures coronary perfusion and prevents complications like stent thrombosis or ischemia.
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The nurse reviews laboratory data for a client with human immunodeficiency virus (HIV) and notes an increased viral load (VL). The nurse reviews the client's current medications and should clarify which medication with the primary healthcare provider (PHCP)?
- A. Acetaminophen
- B. Echinacea
- C. Cetirizine
- D. Calcium carbonate
Correct Answer: B
Rationale: Echinacea, an herbal supplement, may interfere with antiretroviral therapy for HIV, potentially reducing its effectiveness and leading to an increased viral load. Choices A (acetaminophen), C (cetirizine), and D (calcium carbonate) do not have known interactions that significantly impact HIV viral load.
The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first?
- A. Assess respiratory status.
- B. Draw blood for laboratory studies.
- C. Insert a Foley catheter.
- D. Weigh the client.
Correct Answer: A
Rationale: Edema and left ventricular enlargement suggest heart failure, which can cause pulmonary edema. Assessing respiratory status first detects signs of respiratory distress.
A client with renal calculi is prescribed potassium citrate. The purpose is to:
- A. Dissolve stones.
- B. Alkalinize urine.
- C. Reduce pain.
- D. Prevent bleeding.
Correct Answer: B
Rationale: Potassium citrate alkalinizes urine, preventing uric acid stone formation.
Which of the following findings would suggest pneumothorax in a trauma victim?
- A. Pronounced crackles.
- B. Inspiratory wheezing.
- C. Dullness on percussion.
- D. Absent breath sounds.
Correct Answer: D
Rationale: Absent breath sounds on the affected side suggest pneumothorax due to air in the pleural space. Crackles, wheezing, and dullness are more indicative of other conditions.
Cortisone acetate (Cortone) and fludrocortisone acetate (Florinef Acetate) are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy?
- A. Take both drugs three times a day.
- B. Take the entire dose of both drugs first thing in the morning.
- C. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon.
- D. Take half of each drug in the morning and the remaining half of each drug at bedtime.
Correct Answer: C
Rationale: Mimicking diurnal cortisol patterns, most cortisone and all fludrocortisone are taken in the morning, with the remaining cortisone in the afternoon.