Nursing Elites

1. A client with a history of angina pectoris reports chest pain while ambulating in the corridor. What should the nurse do first?

• A. Check the client's vital signs.
• B. Assist the client to sit or lie down.
• C. Administer sublingual nitroglycerin.
• D. Apply nasal oxygen at a rate of 2 L/min.

Correct answer: B

Rationale: When a client with a history of angina pectoris experiences chest pain while ambulating, the priority action for the nurse is to assist the client to sit or lie down. This helps reduce the demand on the heart by decreasing physical exertion. Checking vital signs, administering medication, or applying oxygen can follow once the client is in a more comfortable position. Checking vital signs (Choice A) may be important but addressing the immediate discomfort by positioning the client comfortably takes precedence. Administering sublingual nitroglycerin (Choice C) is appropriate but should come after ensuring the client's comfort. Applying nasal oxygen (Choice D) can be beneficial, but it should not be the first action; assisting the client to sit or lie down is the initial priority.

2. A client with a new prescription for simvastatin is receiving teaching from a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should take this medication in the evening.'
• B. 'I should avoid drinking grapefruit juice.'
• C. 'I should expect my urine to be red-orange while taking this medication.'
• D. 'I will need to take this medication for the rest of my life.'

Correct answer: A

Rationale: The correct answer is A. Taking simvastatin in the evening is recommended because cholesterol synthesis increases at night. This timing maximizes the effectiveness of the medication in lowering cholesterol levels. Choice B is incorrect because grapefruit juice should be avoided with certain statins, but simvastatin is not significantly affected by grapefruit juice. Choice C is incorrect as red-orange urine is not an expected side effect of simvastatin. Choice D is incorrect because simvastatin is typically prescribed for managing cholesterol levels and may not need to be taken for the rest of the client's life.

3. A client has a new prescription for prednisone. Which of the following statements should the nurse include in the teaching?

• A. You may experience weight gain.
• B. Increase your intake of vitamin K.
• C. Expect increased urinary output.
• D. You may have dark, tarry stools.

Correct answer: A

Rationale: The correct answer is A: 'You may experience weight gain.' Prednisone commonly causes weight gain as a side effect, so it is important for the client to be aware of this potential outcome. Monitoring weight changes can be essential in managing the medication's effects and overall health. Choices B, C, and D are incorrect. Increasing vitamin K intake is not specifically related to prednisone use. Expecting increased urinary output is not a common side effect of prednisone. Dark, tarry stools are more commonly associated with gastrointestinal bleeding rather than prednisone use.

4. The healthcare provider is reinforcing instructions to a client with heart failure who is prescribed a low-sodium diet. The provider should advise the client to choose which food item?

• A. Canned soup
• B. Fresh vegetables
• C. Processed cheese
• D. Pickled vegetables

Correct answer: B

Rationale: Fresh vegetables are a suitable choice for clients on a low-sodium diet as they are naturally low in sodium and provide essential nutrients. In contrast, canned soup, processed cheese, and pickled vegetables tend to be high in sodium, which is not recommended for individuals with heart failure and on a low-sodium diet. Fresh vegetables are also rich in fiber, vitamins, and minerals, making them a healthier option compared to the other choices provided.

5. The client with a diagnosis of heart failure is prescribed spironolactone (Aldactone). Which laboratory value should be monitored closely by the nurse?

• A. Serum calcium
• B. Serum potassium
• C. Serum sodium
• D. Serum glucose

Correct answer: B

Rationale: The correct answer is B: Serum potassium. Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia. Monitoring serum potassium levels is crucial to prevent adverse effects associated with high potassium levels, such as cardiac arrhythmias. Monitoring serum calcium (choice A) is not directly related to spironolactone use. Serum sodium (choice C) and serum glucose (choice D) are also not the primary laboratory values to monitor when a client is prescribed spironolactone for heart failure.

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