Nursing Elites

1. The LPN/LVN is assisting in caring for a client in the telemetry unit and is monitoring the client for cardiac changes indicative of hypokalemia. Which occurrence noted on the cardiac monitor indicates the presence of hypokalemia?

• A. Tall, peaked T waves
• B. ST-segment depression
• C. Prolonged P-R interval
• D. Widening of the QRS complex

Correct answer: B

Rationale: ST-segment depression can indicate hypokalemia, affecting the heart's electrical conduction. Hypokalemia leads to alterations in the repolarization phase of the cardiac action potential, resulting in ST-segment depression on the ECG. Tall, peaked T waves are indicative of hyperkalemia, not hypokalemia. A prolonged P-R interval is more commonly associated with first-degree heart block. Widening of the QRS complex is typically seen in conditions like bundle branch blocks or ventricular tachycardia, not specifically in hypokalemia.

2. 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.

3. 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.

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 at risk for thrombophlebitis receives reinforcement from the LPN/LVN regarding measures to minimize its occurrence. Which statement by the client indicates an understanding of this information?

• A. I should avoid sitting for prolonged periods.
• B. I will take frequent walks and avoid prolonged bed rest.
• C. I should drink plenty of fluids to stay hydrated.
• D. I will use compression stockings as advised by my doctor.

Correct answer: B

Rationale: The correct answer is B. Taking frequent walks and avoiding prolonged bed rest are essential measures to promote circulation and reduce the risk of thrombophlebitis. Physical activity helps prevent blood from pooling and clotting in the veins, thus decreasing the likelihood of thrombophlebitis development. Choice A is incorrect because while avoiding prolonged sitting is important, it is not as effective as engaging in physical activity. Choice C is not directly related to preventing thrombophlebitis. Choice D, using compression stockings, is a helpful measure but not as effective as regular physical activity in preventing thrombophlebitis.

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