Nursing Elites

1. 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.

2. The client will wear a Holter monitor for continuous cardiac monitoring over the next 24 hours. What action should the nurse take to assist the client?

• A. Shave the front of the client's chest
• B. Give the client a device holder to wear around the waist
• C. Teach the client to rest as much as possible during the next 24 hours
• D. Tell the client to cover the monitor in plastic wrap before taking a bath

Correct answer: B

Rationale: Providing the client with a device holder to wear around the waist allows them to comfortably carry the Holter monitor while engaging in normal activities throughout the 24-hour monitoring period. This approach supports the client's mobility and ensures the monitor is securely in place for accurate readings. Shaving the front of the client's chest is unnecessary and not a standard practice for Holter monitor placement. Instructing the client to rest as much as possible does not promote normal daily activities which are important for accurate monitoring. Covering the monitor in plastic wrap before bathing is not recommended as it may affect the functionality of the device.

3. A client with chronic stable angina is prescribed nitroglycerin (Nitrostat) for chest pain. The nurse should include which instruction when teaching the client about this medication?

• A. Take nitroglycerin at the first sign of chest pain.
• B. Swallow the tablet whole with water.
• C. Take nitroglycerin with meals to prevent stomach upset.
• D. Store nitroglycerin in a cool, dry place.

Correct answer: A

Rationale: The correct instruction when teaching a client about nitroglycerin (Nitrostat) is to take it at the first sign of chest pain. Nitroglycerin works rapidly to dilate blood vessels, improving blood flow to the heart muscle. Taking it promptly can help alleviate symptoms quickly and prevent the condition from worsening. Choice B is incorrect because nitroglycerin is usually taken sublingually (under the tongue) and not swallowed. Choice C is incorrect because nitroglycerin is not typically taken with meals. Choice D is incorrect because nitroglycerin should be stored in its original container away from heat and light.

4. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed?

• A. Strict bed rest for 24 hours
• B. Bathroom privileges and self-care activities
• C. Unrestricted activities because the client is monitored
• D. Unsupervised hallway ambulation with distances less than 200 feet

Correct answer: B

Rationale: After being transferred from the CCU to the general medical unit with cardiac monitoring, the client with MI is typically prescribed bathroom privileges and self-care activities. This approach allows for gradual recovery and mobility while still being closely monitored, promoting the client's overall well-being and independence. Choice A, strict bed rest for 24 hours, is too restrictive and not recommended for MI patients as it can lead to complications like deep vein thrombosis. Choice C, unrestricted activities, is also not appropriate as MI patients usually require monitoring and gradual re-introduction to activities. Choice D, unsupervised hallway ambulation with distances less than 200 feet, may be too strenuous for a client who just got transferred from the CCU and needs a more gradual approach to activity.

5. A client with a history of heart failure is admitted with a diagnosis of pulmonary edema. Which intervention should the LPN/LVN expect to assist with first?

• A. Administer a diuretic as prescribed.
• B. Place the client in a high Fowler's position.
• C. Prepare the client for intubation.
• D. Insert an indwelling urinary catheter.

Correct answer: B

Rationale: In a client with pulmonary edema, placing them in a high Fowler's position is the priority intervention. This position helps to improve ventilation and oxygenation by decreasing venous return, reducing the workload on the heart, and facilitating fluid redistribution from the lungs. It is crucial to optimize respiratory function and oxygenation before considering other interventions like administering medications, preparing for intubation, or inserting a urinary catheter. Administering a diuretic, preparing for intubation, or inserting a urinary catheter may be necessary but should follow the priority of improving oxygenation through positioning.

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