Nokea
The nurse is preparing the client for an arteriogram. Which instruction is most important to include?
- A. You will need to lie flat for several hours after the procedure.
- B. You can eat a light meal before the test.
- C. Avoid moving your legs during the procedure.
- D. Take your blood pressure medication as usual.
Correct Answer: A
Rationale: Lying flat post-arteriogram prevents bleeding at the catheter insertion site, typically in the femoral artery.
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Which teaching point should the nurse include for a client with heart failure?
- A. Avoid all physical activity.
- B. Report weight gain of 2 pounds or more in a day.
- C. Take extra diuretics if you feel short of breath.
- D. Eat high-sodium foods to maintain electrolytes.
Correct Answer: B
Rationale: Rapid weight gain indicates fluid retention, requiring prompt reporting to manage heart failure.
The nurse is admitting a client diagnosed with peripheral vascular disease. Which data support a diagnosis of venous insufficiency?
- A. The client has bright red skin on the lower extremities.
- B. The client has a brownish purple area on the lower legs.
- C. The client complains of pain after ambulating for short distances.
- D. The client has nonhealing wounds on the toes and ankles.
Correct Answer: B
Rationale: Brownish purple skin (B) indicates hemosiderin from venous stasis. Red skin (A) is nonspecific, pain with walking (C) is arterial, and toe/ankle wounds (D) are arterial.
The 80-year-old client is being discharged home after having surgery to débride a chronic venous ulcer on the right ankle. Which referral would be most appropriate for the client?
- A. Occupational therapist.
- B. Social worker.
- C. Physical therapist.
- D. Cardiac rehabilitation.
Correct Answer: B
Rationale: A social worker (B) coordinates home care for an elderly client with a chronic ulcer. OT (A) and PT (C) are less relevant, and cardiac rehab (D) is unrelated.
The health-care provider prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication?
- A. ACE inhibitors prevent beta receptor stimulation in the heart.
- B. This medication blocks the alpha receptors in the vascular smooth muscle.
- C. ACE inhibitors prevent vasoconstriction and sodium and water retention.
- D. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.
Correct Answer: C
Rationale: ACE inhibitors block angiotensin II, preventing vasoconstriction and sodium/water retention (C), thus lowering BP. Beta (A) and alpha (B) receptors are unrelated, and smooth muscle relaxation (D) is a secondary effect.
Which client would be most likely to develop an abdominal aortic aneurysm?
- A. A 45-year-old female with a history of osteoporosis.
- B. An 80-year-old female with congestive heart failure.
- C. A 69-year-old male with peripheral vascular disease.
- D. A 30-year-old male with a genetic predisposition to AAA.
Correct Answer: C
Rationale: Older males with PVD (C) are at highest risk for AAA due to atherosclerosis. Osteoporosis (A), CHF (B), and young age (D) are lower risk, even with genetics.