Nursing Elites

1. Before administering digoxin (Lanoxin) to a client diagnosed with heart failure, the nurse should perform which assessment?

• A. Check the blood pressure.
• B. Obtain an electrocardiogram (ECG).
• C. Assess the apical pulse.
• D. Review the latest electrolyte levels.

Correct answer: C

Rationale: Assessing the apical pulse is crucial before administering digoxin because the medication can lead to bradycardia. Monitoring the apical pulse helps determine the heart rate, and digoxin is typically withheld if the pulse is below 60 beats per minute. This assessment is essential to prevent potential adverse effects associated with digoxin administration. Checking the blood pressure (Choice A) is important but not specific to digoxin administration. Obtaining an electrocardiogram (ECG) (Choice B) may provide valuable information but is not the primary assessment needed before administering digoxin. Reviewing the latest electrolyte levels (Choice D) is important for assessing the overall condition but is not the immediate assessment required before administering digoxin.

2. The client with a history of angina pectoris is being discharged after coronary artery bypass graft (CABG) surgery. Which statement by the client indicates a need for further teaching?

• A. I will avoid lifting heavy objects for at least 6 weeks.
• B. I will call the doctor if I develop a fever or drainage from my incisions.
• C. I will take my pain medication before doing any activities that might cause discomfort.
• D. I can resume my normal activities, including driving, as soon as I feel like it.

Correct answer: D

Rationale: The correct answer is D because after CABG surgery, patients need to follow specific guidelines for resuming activities, and driving is typically restricted for a certain period to ensure safety and proper recovery. Resuming normal activities too soon, including driving, can pose risks to the client's health and safety. It is essential to emphasize to the client the importance of following the healthcare provider's recommendations regarding activity restrictions post-surgery to prevent complications and promote optimal recovery. Choices A, B, and C are correct statements that align with post-CABG discharge instructions, emphasizing the importance of avoiding heavy lifting, monitoring for signs of infection, and managing pain effectively.

3. A client with a history of coronary artery disease (CAD) is being discharged with a prescription for aspirin. Which instruction should the nurse reinforce with the client?

• A. Take the aspirin on an empty stomach for better absorption.
• B. Stop taking the aspirin if you experience any stomach discomfort.
• C. Take the aspirin with food to reduce the risk of stomach irritation.
• D. Take the aspirin only when you have chest pain.

Correct answer: C

Rationale: The correct instruction is to take the aspirin with food to reduce the risk of stomach irritation. This is crucial for clients with a history of coronary artery disease as it helps minimize gastrointestinal side effects like irritation and bleeding. Option A is incorrect because aspirin should not be taken on an empty stomach to prevent stomach upset. Option B is incorrect because discontinuing aspirin at the first sign of stomach discomfort can be harmful, and a healthcare provider should be consulted instead. Option D is incorrect because aspirin is often prescribed for prevention in cardiovascular conditions, not just for chest pain relief.

4. A client has just completed an information session about measures to minimize the progression of coronary artery disease (CAD). Which statement indicates an initial understanding of lifestyle alterations?

• A. I should take daily medication for life.
• B. I should eat a diet that is low in fat and cholesterol.
• C. I should continue to smoke to keep the metabolic rate high.
• D. I should begin to exercise if the diet is not sufficient to achieve weight loss.

Correct answer: B

Rationale: Choosing a diet that is low in fat and cholesterol is crucial for managing and preventing the progression of coronary artery disease (CAD). This dietary change can help reduce the risk of further complications associated with CAD, such as plaque buildup in the arteries. It is a fundamental lifestyle alteration that can positively impact the client's heart health. Option A is incorrect as relying solely on medication without lifestyle changes may not address the root cause of CAD. Option C is incorrect as smoking is harmful and worsens CAD. Option D is incorrect because exercise is a crucial part of a healthy lifestyle, but dietary changes should come first in managing CAD.

5. A client has a history of left-sided heart failure. The nurse should look for the presence of which finding to determine whether the problem is currently active?

• A. Presence of ascites
• B. Bilateral lung crackles
• C. Jugular vein distention
• D. Pedal edema bilaterally

Correct answer: B

Rationale: When assessing a client with a history of left-sided heart failure, the presence of bilateral lung crackles is a key finding to determine if the condition is currently active. Crackles in the lungs indicate fluid accumulation, a common sign of left-sided heart failure due to pulmonary congestion. Choices A, C, and D are incorrect because ascites, jugular vein distention, and pedal edema are more commonly associated with right-sided heart failure.

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