Nursing Elites

1. The client with a history of coronary artery disease (CAD) is scheduled for a stress test. What instruction should the nurse provide to the client before the test?

• A. Continue taking your usual dose of beta-blockers
• B. Refrain from eating or drinking anything for 4 hours before the test
• C. Wear loose, comfortable clothing and walking shoes
• D. Avoid any physical activity for 24 hours before the test

Correct answer: C

Rationale: Before a stress test, the nurse should instruct the client to wear loose, comfortable clothing and walking shoes. This is essential as the stress test involves physical exercise, and the client should be ready for the activity involved. Continuing beta-blockers should be based on healthcare provider's instructions; adjustments may be needed. Fasting before the test is usually not necessary. Avoiding physical activity for 24 hours before the test is not recommended as it may affect the accuracy of the test results by not providing a true reflection of the client's exercise capacity.

2. A client has a new prescription for atenolol. Which of the following instructions should be included?

• A. Take the medication with food.
• B. Monitor heart rate daily.
• C. Avoid eating foods high in potassium.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct answer is to monitor heart rate daily. Atenolol is a beta-blocker that can lead to bradycardia, a condition characterized by a slow heart rate. Monitoring the heart rate daily is essential to detect any abnormal changes promptly, allowing for timely medical intervention if necessary. Choice A is incorrect because atenolol can be taken with or without food. Choice C is irrelevant as atenolol does not interact with potassium-rich foods. Choice D is incorrect as atenolol is usually taken in the morning to help manage blood pressure throughout the day.

3. A healthcare provider is providing discharge instructions to a client who has a new prescription for digoxin. Which of the following instructions should the healthcare provider include?

• A. Take the medication at bedtime.
• B. Avoid taking antacids with this medication.
• C. Monitor your pulse rate daily.
• D. Increase your intake of potassium-rich foods.

Correct answer: C

Rationale: The correct answer is C: 'Monitor your pulse rate daily.' Monitoring the pulse rate daily is crucial when taking digoxin as it helps in early detection of digoxin toxicity. Digoxin can cause toxicity, which may manifest as changes in the heart rate, making monitoring the pulse rate an essential part of managing the medication. It is important for the client to be aware of their normal pulse rate and report any significant changes to their healthcare provider promptly. Choices A, B, and D are incorrect. Taking digoxin at bedtime is not a specific instruction related to monitoring its effects. Avoiding antacids is relevant for some medications, but not a key concern with digoxin. Increasing potassium-rich foods may interact with digoxin due to its effect on potassium levels, but monitoring the pulse rate is a more direct and immediate need for safety.

4. A healthcare provider is assisting in the care of a client who is having central venous pressure (CVP) measurements taken. The healthcare provider should assist by placing the bed in which position for the reading?

• A. Flat
• B. Semi-Fowler's
• C. Trendelenburg
• D. Reverse Trendelenburg

Correct answer: A

Rationale: Central venous pressure (CVP) measurements are most accurate when the client is lying flat, as this allows for a consistent baseline. Placing the bed flat ensures that the hydrostatic pressure within the vena cava is not affected by the client's position, providing a more precise reading. Choice B (Semi-Fowler's) elevates the head of the bed at a 30-45 degree angle, which could affect the accuracy of CVP readings. Choices C (Trendelenburg) and D (Reverse Trendelenburg) involve extreme positions that would not be suitable for obtaining accurate CVP measurements.

5. 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.

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