LPN LPN
LPN Pharmacology
1. A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. What is the next appropriate nursing action?
- A. Administer another dose of nitroglycerin.
- B. Notify the healthcare provider immediately.
- C. Have the client lie down and stay calm.
- D. Give the client aspirin 325 mg to chew.
Correct answer: A
Rationale: If chest pain persists after the first dose of nitroglycerin, it is appropriate to administer a second dose while continuing to monitor the client's response. Nitroglycerin is a vasodilator commonly used to relieve angina symptoms by dilating blood vessels and increasing blood flow to the heart. Reassessing the client's response and providing a second dose may be necessary to achieve adequate pain relief and improve blood flow to the heart. Administering another dose of nitroglycerin is the next appropriate step in managing angina symptoms. Notifying the healthcare provider immediately (Choice B) may be necessary if the client's condition worsens or if there are other concerning symptoms. Having the client lie down and stay calm (Choice C) is generally recommended but addressing the ongoing chest pain takes precedence. Giving the client aspirin 325 mg to chew (Choice D) is beneficial for suspected myocardial infarction but is not the immediate action indicated for persistent angina symptoms.
2. 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. Choice B, the client's overall physical fitness, is incorrect because the test primarily focuses on the heart's response to stress rather than the client's general physical fitness. Choice C, the presence of electrolyte imbalances, is incorrect as this test is not specifically designed to evaluate electrolyte levels. Choice D, the effectiveness of anti-anginal medications, is incorrect as the main purpose of the test is to assess the heart's response to physical stress, not medication effectiveness.
3. A healthcare provider is assisting in the care of a client who is having central venous pressure (CVP) measurements taken. The healthcare provider should assist by placing the bed in which position for the reading?
- A. Flat
- B. Semi-Fowler's
- C. Trendelenburg
- D. Reverse Trendelenburg
Correct answer: A
Rationale: Central venous pressure (CVP) measurements are most accurate when the client is lying flat, as this allows for a consistent baseline. Placing the bed flat ensures that the hydrostatic pressure within the vena cava is not affected by the client's position, providing a more precise reading. Choice B (Semi-Fowler's) elevates the head of the bed at a 30-45 degree angle, which could affect the accuracy of CVP readings. Choices C (Trendelenburg) and D (Reverse Trendelenburg) involve extreme positions that would not be suitable for obtaining accurate CVP measurements.
4. The client's B-type natriuretic peptide (BNP) level is 691 pg/mL. Which intervention should the nurse implement when providing care for the client?
- A. Take daily weights and monitor trends.
- B. Encourage fluid intake to improve hydration.
- C. Elevate the legs above the level of the heart.
- D. Position the client supine with the head of the bed at 30 degrees.
Correct answer: A
Rationale: Elevated BNP levels are indicative of heart failure, which often causes fluid retention and weight gain. Taking daily weights and monitoring trends allows the nurse to assess for changes in fluid status. This intervention helps in evaluating the effectiveness of the treatment plan and identifying worsening heart failure symptoms early. Encouraging fluid intake (Choice B) might exacerbate fluid overload in a client with elevated BNP levels. Elevating the legs (Choice C) and positioning the client supine with the head of the bed at 30 degrees (Choice D) are interventions more suitable for clients with hypotension, not specifically indicated for managing elevated BNP levels.
5. A client with peripheral arterial disease complains of leg pain while walking. The nurse should reinforce which teaching point with the client?
- A. Wear compression stockings daily.
- B. Increase daily walking distance gradually.
- C. Elevate legs above heart level when resting.
- D. Use a heating pad to soothe leg muscles.
Correct answer: B
Rationale: For clients with peripheral arterial disease experiencing leg pain while walking, the priority teaching point is to gradually increase daily walking distance. This approach helps improve circulation, build tolerance, and reduce symptoms over time. While compression stockings can be beneficial for circulation, they are not the priority teaching point in this scenario. Elevating legs above heart level when resting is more appropriate for clients with venous insufficiency, not peripheral arterial disease. Using a heating pad is not recommended as it can potentially cause burns or skin damage in clients with compromised circulation.
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