Nursing Elites

1. Which statement indicates that a client with coronary artery disease (CAD) understands disease management?

• A. I will walk for one-half hour daily.
• B. As long as I exercise, I can eat anything I wish.
• C. My weight plays no role in this disease.
• D. My father's high cholesterol is irrelevant.

Correct answer: A

Rationale: Choice A is the correct answer because regular physical activity, such as walking for half an hour daily, is beneficial for managing coronary artery disease (CAD) and promoting heart health. Walking helps improve circulation, reduce cholesterol levels, and maintain a healthy weight, all of which are crucial for managing CAD. Choice B is incorrect because diet also plays a significant role in CAD management, not just exercise. Choice C is incorrect because weight management is essential in controlling CAD risk factors. Choice D is incorrect because family history of high cholesterol can increase the risk of CAD, making it relevant for disease management.

2. The healthcare provider is reviewing the medication orders for a client with angina pectoris. Which medication is typically prescribed to prevent angina attacks?

• A. Aspirin
• B. Nitroglycerin
• C. Atenolol
• D. Simvastatin

Correct answer: B

Rationale: Nitroglycerin is the medication typically prescribed to prevent angina attacks. It works by dilating blood vessels, increasing blood flow, and reducing the heart's workload, hence relieving angina symptoms. Aspirin is often used to prevent blood clots, not specifically to prevent angina attacks. Atenolol is a beta-blocker used to manage high blood pressure and chest pain but is not typically prescribed to prevent angina attacks. Simvastatin is a statin medication primarily used to lower cholesterol levels and is not indicated for preventing angina attacks.

3. The client is receiving heparin therapy for deep vein thrombosis (DVT). Which lab test should be monitored to evaluate the effectiveness of heparin?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Fibrinogen levels

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the appropriate lab test to monitor the therapeutic effectiveness of heparin therapy. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure the client is within the therapeutic range to prevent clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, a different anticoagulant that affects the extrinsic pathway of the coagulation cascade. Fibrinogen levels are not specific to monitoring heparin therapy.

4. A client diagnosed with coronary artery disease (CAD) reports chest pain radiating to the left arm. 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 helps dilate blood vessels and improve blood flow to the heart, relieving chest pain associated with coronary artery disease. Reassessing the client's response to a second dose is crucial before considering other interventions like contacting the healthcare provider or providing additional medications. Administering another dose of nitroglycerin aligns with the standard protocol for managing ongoing chest pain in clients with CAD.

5. The client with chronic stable angina is prescribed a beta blocker. The nurse is reinforcing instructions. What instruction should the nurse include?

• A. Take the medication with a meal.
• B. Report a pulse rate below 60 beats per minute.
• C. Discontinue the medication if dizziness occurs.
• D. Avoid drinking grapefruit juice.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to report a pulse rate below 60 beats per minute. Beta blockers are known to lower heart rate, and a pulse rate below 60 beats per minute may indicate bradycardia, a condition that requires medical attention. Option A, 'Take the medication with a meal,' is incorrect because beta blockers don't necessarily need to be taken with food. Option C, 'Discontinue the medication if dizziness occurs,' is incorrect because abrupt cessation of beta blockers can lead to rebound hypertension and other adverse effects. Option D, 'Avoid drinking grapefruit juice,' is unrelated to beta blockers' mechanism of action or side effects.

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