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The LPN/LVN is reinforcing instructions to a client on the use of a metered-dose inhaler. The nurse should recognize that the client is using the inhaler correctly if the client takes which action?
- A. Takes a deep breath and then exhales just before administration
- B. Holds the mouthpiece 1 to 2 inches from the mouth
- C. Inhales the medication and then exhales immediately after administration
- D. Performs 3 short inhalations and then exhales deeply after administration
Correct Answer: A
Rationale: When using a metered-dose inhaler, the client should take a deep breath and then exhale just before administration. This technique helps ensure that the medication is inhaled effectively. By exhaling before administration, the client can fully inhale the medication into the lungs, maximizing its therapeutic effects.
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A client is admitted with an arterial ischemic leg ulcer. The nurse expects to note that this ulcer has which typical characteristic?
- A. Dark pink base
- B. Deep and painful
- C. Accompanied by very slight pain
- D. Brown pigmentation of surrounding skin
Correct Answer: B
Rationale: Arterial ischemic ulcers are typically characterized by being deep and painful, often with a pale or necrotic base. The lack of adequate blood flow leads to tissue damage, resulting in these ulcers having a deep appearance and causing significant pain to the individual. The other options are not commonly associated with arterial ischemic ulcers; a dark pink base, very slight pain, or brown pigmentation of surrounding skin are not typical features of this type of ulcer.
The client with Raynaud's phenomenon is being taught by the nurse about preventing episodes. Which instruction should the nurse reinforce?
- A. Wear gloves in cold weather.
- B. Avoid caffeine and chocolate.
- C. Increase intake of vitamin C.
- D. Use a heating pad for warmth.
Correct Answer: A
Rationale: Wearing gloves in cold weather is essential for preventing vasoconstriction and subsequent episodes of Raynaud's phenomenon. Cold temperatures can trigger vasospasms in individuals with Raynaud's, and wearing gloves helps maintain warmth and prevent the constriction of blood vessels in the extremities, reducing the likelihood of an episode.
A client with a history of angina is scheduled for an exercise electrocardiography (ECG) test. The nurse should explain that the purpose of this test is to evaluate which factor?
- A. The heart's response to physical stress
- B. The client's overall physical fitness
- C. The presence of electrolyte imbalances
- D. The effectiveness of anti-anginal medications
Correct Answer: A
Rationale: An exercise electrocardiography (ECG) test is used to evaluate the heart's response to physical stress. During the test, the heart's electrical activity is monitored while the client exercises, helping to identify any areas of ischemia or abnormal rhythms. This test helps healthcare providers assess the heart's function and detect any potential issues related to angina or other cardiac conditions.
When assisting a hospitalized client newly diagnosed with coronary artery disease (CAD) to make appropriate selections from the dietary menu, which meal should the nurse encourage the client to select?
- A. Sausage, pancakes, and toast
- B. Broccoli, buttered rice, and grilled chicken
- C. Hamburger, baked apples, and avocado salad
- D. Fresh strawberries, steamed vegetables, and baked fish
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Before administering digoxin (Lanoxin) to a client diagnosed with heart failure, the nurse should perform which assessment?
- A. Check the blood pressure.
- B. Obtain an electrocardiogram (ECG).
- C. Assess the apical pulse.
- D. Review the latest electrolyte levels.
Correct Answer: C
Rationale: Assessing the apical pulse is crucial before administering digoxin because the medication can lead to bradycardia. Monitoring the apical pulse helps determine the heart rate, and digoxin is typically withheld if the pulse is below 60 beats per minute. This assessment is essential to prevent potential adverse effects associated with digoxin administration.