Nokea
The nurse is discussing the importance of exercise with the client diagnosed with coronary artery disease. Which intervention should the nurse implement?
- A. Perform isometric exercises daily.
- B. Walk for 15 minutes three (3) times a week.
- C. Do not walk outside if it is less than 40°F.
- D. Wear open-toed shoes when ambulating.
Correct Answer: B
Rationale: Walking 15 minutes 3 times a week (B) is a safe, aerobic exercise for CAD. Isometric exercises (A) increase BP, cold weather (C) is a precaution, and open-toed shoes (D) are irrelevant.
You may also like to solve these questions
The client with coronary artery disease asks the nurse, 'Why do I get chest pain?' Which statement would be the most appropriate response by the nurse?
- A. Chest pain is caused by decreased oxygen to the heart muscle.'
- B. There is ischemia to the myocardium as a result of hypoxemia.'
- C. The heart muscle is unable to pump effectively to perfuse the body.'
- D. Chest pain occurs when the lungs cannot adequately oxygenate the blood.'
Correct Answer: A
Rationale: Chest pain in CAD is due to decreased oxygen to the heart muscle (A), a clear explanation. Ischemia/hypoxemia (B) is technical, pumping (C) relates to heart failure, and lungs (D) are incorrect.
The nurse is caring for a client diagnosed with coronary artery disease (CAD). Which should the nurse teach the client prior to discharge?
- A. Carry your nitroglycerin tablets in a brown bottle.
- B. Swallow a nitroglycerin tablet at the first sign of angina.
- C. If one nitroglycerin tablet does not work in 10 minutes, take another.
- D. Nitroglycerin tablets have a fruity odor if they are potent.
Correct Answer: A
Rationale: Nitroglycerin should be stored in a dark bottle (A) to maintain potency. Swallowing (B) is incorrect (sublingual), 10 minutes (C) should be 5, and fruity odor (D) is not a potency indicator.
Which assessment data would the nurse expect to auscultate in the client diagnosed with mitral valve insufficiency?
- A. A loud S1, S2 split, and a mitral opening snap.
- B. A holosystolic murmur heard best at the cardiac apex.
- C. A midsystolic ejection click or murmur heard at the base.
- D. A high-pitched sound heard at the third left intercostal space.
Correct Answer: B
Rationale: Mitral insufficiency (regurgitation) causes a holosystolic murmur at the apex (B) due to backflow. S1/S2 snap (A) is mitral stenosis, ejection click (C) is aortic/pulmonic, and high-pitched sound (D) is nonspecific.
Which potential complication should the nurse assess for in the client with infective endocarditis who has embolization of vegetative lesions from the mitral valve?
- A. Pulmonary embolus (PE).
- B. Cerebrovascular accident.
- C. Hemoptysis.
- D. Deep vein thrombosis.
Correct Answer: B
Rationale: Mitral valve vegetations can embolize to the brain, causing a stroke (B). PE (A) is right-sided, hemoptysis (C) is not typical, and DVT (D) is unrelated to embolization.
Which intervention should the nurse implement when defibrillating a client who is in ventricular fibrillation?
- A. Defibrillate the client at 50, 100, and 200 joules.
- B. Do not remove the oxygen source during defibrillation.
- C. Place petroleum jelly on the defibrillator pads.
- D. Shout 'all clear' prior to defibrillating the client.
Correct Answer: D
Rationale: Shouting 'all clear' (D) ensures safety before defibrillation. Energy levels (A) are 200–360 joules, oxygen (B) is removed to prevent fire, and petroleum jelly (C) is not used.