Nokea
The nurse is teaching a client with pericarditis about activity restrictions. Which instruction is most appropriate?
- A. Resume normal activity immediately.
- B. Rest and avoid strenuous activity.
- C. Engage in high-intensity exercise.
- D. Lift heavy objects to build strength.
Correct Answer: B
Rationale: Rest prevents exacerbation of pericardial inflammation and promotes healing.
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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.
Which activity should the nurse advise a client with cardiomyopathy to avoid?
- A. Walking at a moderate pace
- B. Heavy weightlifting
- C. Swimming for 20 minutes
- D. Yoga with gentle stretches
Correct Answer: B
Rationale: Heavy weightlifting increases cardiac strain, which is dangerous in cardiomyopathy.
The client with varicose veins is six (6) hours postoperative vein ligation. Which nursing intervention should the nurse implement first?
- A. Assist the client to dangle the legs off the side of the bed.
- B. Assess and maintain pressure bandages on the affected leg.
- C. Apply a sequential compression device to the affected leg.
- D. Administer the prescribed prophylactic intravenous antibiotic.
Correct Answer: B
Rationale: Assessing/maintaining pressure bandages (B) prevents bleeding post-vein ligation. Dangling (A) is premature, compression devices (C) are secondary, and antibiotics (D) follow assessment.
The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse?
- A. The telemetry reads normal sinus rhythm.
- B. The client has a weight gain of 2 kg within 1 to 2 days.
- C. The client's blood pressure is 148/92.
- D. The client's serum potassium level is 4.5 mEq.
Correct Answer: B
Rationale: Weight gain of 2 kg in 1–2 days (B) indicates fluid retention, a serious issue in hypertension requiring intervention. Normal sinus rhythm (A), BP 148/92 (C), and K+ 4.5 (D) are not urgent.
The client is diagnosed with a small abdominal aortic aneurysm. Which interventions should be included in the discharge teaching? Select all that apply.
- A. Tell the client to exercise three (3) times a week for 30 minutes.
- B. Encourage the client to eat a low-fat, low-cholesterol diet.
- C. Instruct the client to decrease tobacco use.
- D. Discuss the importance of losing weight with the client.
- E. Teach the client to wear a truss at all times.
Correct Answer: A,B,C,D
Rationale: Exercise (A), low-fat diet (B), smoking reduction (C), and weight loss (D) reduce AAA progression. Trusses (E) are irrelevant to AAA management.