Nokea
Which electrolyte imbalance should the nurse monitor in a client with arrhythmias?
- A. Calcium
- B. Potassium
- C. Sodium
- D. Magnesium
Correct Answer: B
Rationale: Potassium imbalances can trigger or worsen arrhythmias by affecting cardiac cell membrane potential.
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Which activity should the nurse encourage for a client with heart failure?
- A. Walking at a slow pace daily.
- B. Lifting heavy weights.
- C. Running for 30 minutes daily.
- D. Remaining on bedrest.
Correct Answer: A
Rationale: Low-intensity exercise like walking improves cardiovascular fitness without overstraining the heart.
The HCP prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with CAD. Which should the nurse teach the client about this medication?
- A. Take this medication on an empty stomach.
- B. This medication should be taken in the evening.
- C. Do not be concerned if muscle pain occurs.
- D. Check your cholesterol level daily.
Correct Answer: B
Rationale: Statins are most effective in the evening (B) due to cholesterol synthesis peaking at night. Food (A) enhances absorption, muscle pain (C) requires reporting, and daily checks (D) are unnecessary.
The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement?
- A. Keep the right leg in the dependent position.
- B. Apply sequential compression devices to lower extremities.
- C. Monitor the client's pedal pulses every shift.
- D. Assess the client's leg dressing every four (4) hours.
Correct Answer: C
Rationale: Monitoring pedal pulses (C) assesses graft patency post-bypass, critical to ensure circulation. Dependent position (A) impairs flow, compression devices (B) are for venous issues, and dressing checks (D) are routine but secondary.
The nurse just received the a.m. shift report. Which client should the nurse assess first?
- A. The client diagnosed with coronary artery disease who has a BP of 170/100.
- B. The client diagnosed with DVT who is complaining of chest pain.
- C. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%.
- D. The client diagnosed with ulcerative colitis who has non-bloody diarrhea.
Correct Answer: B
Rationale: Chest pain in DVT (B) suggests pulmonary embolism, a life-threatening emergency. Hypertension (A) is urgent but less immediate, SpO2 98% (C) is normal, and diarrhea (D) is non-emergent.
The client diagnosed with acute deep vein thrombosis is receiving a continuous heparin drip, an intravenous anticoagulant. The healthcare provider orders warfarin (Coumadin), an oral anticoagulant. Which action should the nurse take?
- A. Discontinue the heparin drip prior to initiating the Coumadin.
- B. Check the client's INR prior to beginning Coumadin.
- C. Clarify the order with the health-care provider as soon as possible.
- D. Administer the Coumadin along with the heparin drip as ordered.
Correct Answer: D
Rationale: Heparin and warfarin are often overlapped for 3–5 days in acute DVT until warfarin’s INR is therapeutic (D). Discontinuing heparin (A) is premature, INR (B) is checked later, and clarification (C) is unnecessary.