Nursing Elites

1. What preoperative instruction should the LPN/LVN reinforce to a client scheduled for a carotid endarterectomy?

• A. You will need to be NPO after midnight before the surgery.
• B. You should avoid deep breathing and coughing after the surgery.
• C. You will be able to eat and drink normally after the procedure.
• D. You can take all of your prescribed medications the morning of surgery.

Correct answer: A

Rationale: The correct preoperative instruction that the LPN/LVN should reinforce to a client scheduled for a carotid endarterectomy is being NPO after midnight before the surgery. This instruction is essential to prevent aspiration and ensure a safe procedure. Avoiding oral intake helps reduce the risk of complications during anesthesia induction and the surgical process. Choices B, C, and D are incorrect because avoiding deep breathing and coughing, resuming normal eating and drinking, and taking all prescribed medications the morning of surgery are not recommended preoperative instructions for a carotid endarterectomy.

2. The client admitted to the hospital with pulmonary edema is preparing for discharge. The client should be reminded of the importance of complying with which measure to prevent a recurrence?

• A. Weigh oneself every morning before breakfast.
• B. Sleep with the head elevated on multiple pillows.
• C. Adjust diuretic dose without healthcare provider guidance.
• D. Take additional digoxin (Lanoxin) as a preventive measure.

Correct answer: A

Rationale: Monitoring weight daily, especially in the morning before breakfast, is crucial in detecting fluid retention early and preventing pulmonary edema. Sudden weight gain can indicate fluid accumulation, prompting timely intervention to prevent complications. Choice A is the correct answer because daily weight monitoring is a key component in managing heart failure and preventing pulmonary edema recurrence. Choices B and D are not directly related to preventing fluid retention or pulmonary edema recurrence. Choice C is unsafe as adjusting diuretic doses without healthcare provider guidance can lead to electrolyte imbalances and worsening of the condition.

3. The LPN/LVN is reinforcing discharge instructions to a client who has been prescribed nitroglycerin sublingual tablets for angina. Which statement by the client indicates a need for further teaching?

• A. I will keep my nitroglycerin tablets in the original glass bottle.
• B. I will sit or lie down when I take a nitroglycerin tablet.
• C. I will take a nitroglycerin tablet every 5 minutes if chest pain persists, up to a total of 3 tablets.
• D. I can swallow the nitroglycerin tablet with a glass of water if it does not dissolve quickly.

Correct answer: D

Rationale: The correct answer is D. Nitroglycerin sublingual tablets should not be swallowed; they must dissolve under the tongue to be effective. Choice A is correct as nitroglycerin tablets should be stored in their original glass container to prevent degradation. Choice B is correct as sitting or lying down when taking a nitroglycerin tablet helps prevent dizziness or fainting due to a sudden drop in blood pressure. Choice C is correct as taking a nitroglycerin tablet every 5 minutes for a maximum of 3 tablets is the correct protocol for managing angina symptoms.

4. A healthcare professional is providing discharge teaching to a client who has a new prescription for enoxaparin. Which of the following instructions should the healthcare professional include?

• A. Administer the injection into the abdomen.
• B. Avoid massaging the injection site after administration.
• C. Expect mild bruising at the injection site.
• D. Avoid alternating injection sites between the arms.

Correct answer: A

Rationale: Administering enoxaparin into the abdomen is recommended to ensure proper absorption and effectiveness. Massaging the injection site after administration should be avoided as it can increase the risk of bleeding or bruising. Mild bruising at the injection site is common with enoxaparin and should be expected. Alternating injection sites, especially between arms, is not suitable for enoxaparin administration. Consistent administration into the abdomen is preferred for consistent absorption of the medication.

5. The LPN/LVN is assisting in the care of a client with chronic heart failure who is receiving digoxin (Lanoxin). Which sign should the nurse monitor for that could indicate digoxin toxicity?

• A. Bradycardia
• B. Tachycardia
• C. Hypertension
• D. Hyperglycemia

Correct answer: A

Rationale: Bradycardia is a common sign of digoxin toxicity and should be closely monitored. Digoxin toxicity can lead to various cardiac dysrhythmias, with bradycardia being a significant indicator. Monitoring the client's heart rate is crucial to detect and manage digoxin toxicity promptly. Tachycardia, hypertension, and hyperglycemia are not typically associated with digoxin toxicity. Tachycardia is more commonly seen with inadequate treatment of heart failure, hypertension is a possible but less common effect, and hyperglycemia is not a typical sign of digoxin toxicity.

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