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The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure?
- A. Perform passive range-of-motion exercises.
- B. Assess the client's neurovascular status.
- C. Keep the client in high Fowler's position.
- D. Assess the gag reflex prior to feeding the client.
Correct Answer: B
Rationale: Post-catheterization, assessing neurovascular status (B) ensures no bleeding or vascular complications. ROM (A) is inappropriate, high Fowler’s (C) is not required, and gag reflex (D) is irrelevant.
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The client is admitted to the medical unit to rule out carditis. Which question should the nurse ask the client during the admission interview to support this diagnosis?
- A. Have you had a sore throat in the last month?'
- B. Did you have rheumatic fever as a child?'
- C. Do you have a family history of carditis?'
- D. What over-the-counter (OTC) medications do you take?'
Correct Answer: B
Rationale: Rheumatic fever (B) is a major cause of carditis, especially in children, making it the most relevant question. Sore throat (A) is less specific, family history (C) is rare, and OTC meds (D) are unrelated.
Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? Select all that apply.
- A. Encourage a low-fat, low-cholesterol diet.
- B. Instruct the client to walk 30 minutes a day.
- C. Decrease the salt intake to two (2) g a day.
- D. Refer to a counselor for stress reduction techniques.
- E. Teach the client to increase fiber in the diet.
Correct Answer: A,B,D,E
Rationale: Low-fat/cholesterol diet (A), walking (B), stress reduction (D), and high-fiber diet (E) reduce CAD risk. Salt restriction (C) is more specific to CHF or hypertension.
The client has just received a mechanical valve replacement. Which behavior by the client indicates the client needs more teaching?
- A. The client takes prophylactic antibiotics.
- B. The client uses a soft-bristle toothbrush.
- C. The client takes an enteric-coated aspirin daily.
- D. The client alternates rest with activity.
Correct Answer: C
Rationale: Aspirin (C) is not routinely required post-mechanical valve; warfarin is standard. Antibiotics (A), soft toothbrush (B), and rest/activity (D) are appropriate.
The client with coronary artery disease is prescribed transdermal nitroglycerin, a coronary vasodilator. Which behavior indicates the client understands the discharge teaching concerning this medication?
- A. The client places the medication under the tongue.
- B. The client removes the old patch before placing the new.
- C. The client applies the patch to a hairy area.
- D. The client changes the patch every 36 hours.
Correct Answer: B
Rationale: Removing the old patch (B) ensures proper dosing and prevents overdose. Sublingual (A) is incorrect, hairy areas (C) reduce adhesion, and patches are changed every 24 hours (D).
The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina?
- A. Put a nitroglycerin tablet under the tongue.
- B. Stop the activity immediately and rest.
- C. Document when and what activity caused angina.
- D. Notify the health-care provider immediately.
Correct Answer: B
Rationale: Stopping activity and resting (B) reduces oxygen demand, the first step in angina. Nitroglycerin (A) follows, documenting (C) is later, and notifying HCP (D) is for persistent pain.