Nursing Elites

1. A client is admitted to the emergency department with a suspected myocardial infarction (MI). The nurse should prepare the client for which immediate diagnostic test?

• A. Chest x-ray
• B. Electrocardiogram (ECG)
• C. Echocardiogram
• D. Coronary angiography

Correct answer: B

Rationale: An Electrocardiogram (ECG) is the most immediate and essential test to diagnose a myocardial infarction (MI) and assess the extent of heart damage. An ECG can quickly identify changes in the heart's electrical activity, allowing prompt initiation of appropriate interventions. A chest x-ray (Choice A) may show other conditions affecting the heart, but it is not the immediate test of choice for diagnosing an MI. An echocardiogram (Choice C) and coronary angiography (Choice D) are valuable in further assessing cardiac function and anatomy post-MI but are not the first-line diagnostic tests due to their time-consuming nature compared to an ECG.

2. Why should the client diagnosed with rheumatic heart disease be advised to notify the dentist before dental procedures?

• A. The client requires prophylactic antibiotics before treatment.
• B. The client may experience dysrhythmias with high-speed drills.
• C. The client may have an adverse reaction to lidocaine with epinephrine.
• D. The client may develop heart failure during stressful events.

Correct answer: A

Rationale: Clients with rheumatic heart disease are at risk for infective endocarditis, a serious infection of the heart lining or valves. They need prophylactic antibiotics before invasive procedures, including dental work, to prevent this life-threatening complication. While dysrhythmias with high-speed drills, adverse reactions to local anesthesia, and the risk of heart failure during stressful events are all concerns for clients with heart conditions, the primary reason for notifying the dentist before dental procedures in rheumatic heart disease is the need for prophylactic antibiotics to prevent infective endocarditis.

3. The healthcare provider is reinforcing teaching for a client who is starting statin therapy. Which dietary advice should the healthcare provider give?

• A. Eat more whole grains.
• B. Avoid foods high in potassium.
• C. Avoid grapefruit and grapefruit juice.
• D. Increase intake of dairy products.

Correct answer: C

Rationale: The correct answer is C: Avoid grapefruit and grapefruit juice. Grapefruit and grapefruit juice can interfere with the metabolism of statins, leading to an increased risk of adverse effects. It is crucial for clients on statin therapy to avoid grapefruit products to ensure the medication's effectiveness and safety. Choices A, B, and D are incorrect because they do not directly impact the metabolism or effectiveness of statin therapy.

4. A healthcare provider is assessing a client who has been taking lisinopril. Which of the following findings should the provider report?

• A. Dry cough
• B. Hyperkalemia
• C. Elevated blood pressure
• D. Increased appetite

Correct answer: A

Rationale: The correct answer is A: Dry cough. A dry cough is a common side effect of lisinopril. It is essential to report this to the healthcare provider as it may indicate the need to discontinue the medication to prevent further complications such as angioedema or cough that can persist for weeks to months after stopping the medication. Choice B, hyperkalemia, is not typically associated with lisinopril use; instead, it is a possible side effect of medications like potassium-sparing diuretics. Choice C, elevated blood pressure, would not be a concerning finding as lisinopril is often prescribed to lower blood pressure. Choice D, increased appetite, is not a common side effect of lisinopril and would not typically warrant immediate reporting.

5. The client is being taught about the use of sublingual nitroglycerin for chest pain. Which instruction should be provided?

• A. Swallow the tablet whole with water.
• B. Place the tablet under the tongue and let it dissolve.
• C. Chew the tablet and then swallow.
• D. Place the tablet between the cheek and gum.

Correct answer: B

Rationale: The correct method for administering sublingual nitroglycerin is to place the tablet under the tongue and allow it to dissolve. This route of administration facilitates rapid absorption of the medication into the bloodstream, enabling quick relief of chest pain associated with angina or heart conditions. Choice A is incorrect because sublingual nitroglycerin should not be swallowed whole. Choice C is wrong as chewing the tablet can lead to the rapid release of the drug, causing adverse effects like headaches or dizziness. Choice D is also incorrect as the tablet should not be placed between the cheek and gum, but under the tongue for proper absorption.

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