Nokea
The LPN/LVN is assisting with the care of a client who has been diagnosed with a myocardial infarction (MI). Which laboratory test result would the nurse expect to see elevated within the first 24 hours of the client's admission?
- A. Serum troponin
- B. Serum creatinine
- C. Serum sodium
- D. Serum albumin
Correct Answer: A
Rationale: Elevated serum troponin levels are indicative of myocardial damage and are commonly used as a diagnostic marker for myocardial infarction. Troponin levels typically rise within a few hours of an MI and remain elevated for several days, making it a crucial test for early detection and monitoring of cardiac injury. Serum creatinine is not typically elevated in the acute phase of a myocardial infarction. Serum sodium and serum albumin levels are not directly associated with myocardial infarction and are unlikely to be elevated in the first 24 hours following an MI.
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The healthcare professional is reinforcing teaching for a client with peripheral artery disease (PAD). Which statement by the client indicates a need for further teaching?
- A. I will keep my legs elevated on pillows while resting.
- B. I will avoid crossing my legs when sitting.
- C. I will wear loose-fitting, comfortable shoes.
- D. I will avoid exposure to cold temperatures.
Correct Answer: A
Rationale: The correct answer is A. Elevating the legs can decrease blood flow in clients with PAD, worsening symptoms. Therefore, advising the client to keep the legs elevated on pillows while resting is incorrect and can exacerbate the condition. Choice B is correct as avoiding crossing legs helps prevent circulation restriction. Choice C is correct as wearing loose-fitting shoes promotes circulation. Choice D is correct as avoiding exposure to cold temperatures helps prevent vasoconstriction, which can worsen PAD symptoms.
The client is reinforcing teaching for peripheral artery disease (PAD). Which statement by the client indicates correct understanding?
- A. I will keep my legs elevated on pillows while resting.
- B. I will avoid crossing my legs when sitting.
- C. I will wear tight compression stockings to improve circulation.
- D. I will apply heat to my legs to relieve pain and improve circulation.
Correct Answer: B
Rationale: The correct answer is B. Crossing the legs can further impede blood flow in clients with PAD, worsening symptoms. Avoiding leg crossing helps maintain adequate blood flow and reduces the risk of complications associated with peripheral artery disease. Choices A, C, and D are incorrect because elevating the legs, wearing tight compression stockings, and applying heat can exacerbate symptoms in PAD by restricting blood flow or causing potential harm.
The client with deep vein thrombosis (DVT) is receiving anticoagulant therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the therapy?
- A. Complete blood count (CBC)
- B. Activated partial thromboplastin time (aPTT)
- C. Serum electrolytes
- D. Liver function tests
Correct Answer: B
Rationale: Activated partial thromboplastin time (aPTT) is the correct laboratory test to monitor the effectiveness of anticoagulant therapy, especially with heparin. A prolonged aPTT indicates effective anticoagulation, reducing the risk of further clot formation in the client with deep vein thrombosis (DVT). The other options, such as complete blood count (CBC), serum electrolytes, and liver function tests, do not directly assess the therapeutic effectiveness of anticoagulant therapy. Therefore, the correct answer is B.
The healthcare provider is caring for a client with hypertension who is receiving a beta blocker. The provider should monitor for which potential side effect?
- A. Tachycardia
- B. Bradycardia
- C. Hypertension
- D. Hyperglycemia
Correct Answer: B
Rationale: Corrected Rationale: Beta blockers are medications that can cause bradycardia by slowing down the heart rate. It is essential to monitor for this side effect in clients receiving beta blockers, as it can lead to serious complications such as decreased cardiac output and hypotension. Choices A, C, and D are incorrect because beta blockers are not expected to cause tachycardia (fast heart rate), hypertension (high blood pressure), or hyperglycemia (high blood sugar levels).
The healthcare provider is reinforcing instructions to a client with heart failure who is prescribed a low-sodium diet. The provider should advise the client to choose which food item?
- A. Canned soup
- B. Fresh vegetables
- C. Processed cheese
- D. Pickled vegetables
Correct Answer: B
Rationale: Fresh vegetables are a suitable choice for clients on a low-sodium diet as they are naturally low in sodium and provide essential nutrients. In contrast, canned soup, processed cheese, and pickled vegetables tend to be high in sodium, which is not recommended for individuals with heart failure and on a low-sodium diet. Fresh vegetables are also rich in fiber, vitamins, and minerals, making them a healthier option compared to the other choices provided.