Nursing Elites

1. In preparation for the discharge of a client with peripheral arterial disease (PAD), the nurse should include which of the following instructions?

• A. Apply a heating pad on a low setting to help relieve leg pain.
• B. Adjust the thermostat so that the environment is warm.
• C. Wear antiembolic stockings during the day.
• D. Rest with the legs above heart level.

Correct answer: D

Rationale: Resting with the legs above heart level is important for clients with peripheral arterial disease (PAD) to promote better circulation and reduce leg pain. Applying a heating pad on a low setting can actually worsen symptoms by causing burns or increasing blood flow to the area, which is not recommended for PAD. While keeping the environment warm is generally beneficial, it is not a specific instruction for managing PAD. Antiembolic stockings are typically used for preventing blood clots in hospitalized patients and may not be directly related to managing PAD at home.

2. A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

• A. Pigeon
• B. Funnel
• C. Kyphotic
• D. Barrel

Correct answer: D

Rationale: When assessing a client with COPD, the nurse should expect the client's chest to be barrel-shaped. This shape is a classic characteristic of COPD due to hyperinflation of the lungs. A 'Pigeon' chest shape is associated with pectus carinatum, a deformity of the chest wall. A 'Funnel' chest shape is seen in conditions like pectus excavatum. 'Kyphotic' refers to an exaggerated outward curvature of the thoracic spine. Therefore, the correct answer is 'Barrel' as it is the expected chest shape in clients with COPD.

3. When caring for a client with COPD, which intervention should the nurse include in the care plan?

• A. Restrict the client's fluid intake to less than 2 L/day.
• B. Encourage the client to use the upper chest for respiration.
• C. Have the client use the early-morning hours for exercise and activity.
• D. Instruct the client to use pursed-lip breathing.

Correct answer: D

Rationale: The correct answer is to instruct the client to use pursed-lip breathing. This technique helps improve breathing efficiency by keeping the airways open during exhalation and reducing air trapping. Restricting fluid intake to less than 2 L/day is not appropriate for a client with COPD, as they need adequate hydration. Using the upper chest for respiration is incorrect as it promotes shallow breathing, which is not ideal for COPD patients. While exercise is beneficial, early-morning hours may not be the best time for clients with COPD due to increased respiratory distress in the morning.

4. A nurse at a provider's office receives a phone call from a client who reports unrelieved chest pain after taking a nitroglycerin (Nitrostat) tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?

• A. Tell the client to take an aspirin.
• B. Instruct the client to call 911.
• C. Have the client take another nitroglycerin tablet in 15 minutes.
• D. Advise the client to come to the office.

Correct answer: B

Rationale: In this scenario, the client reporting unrelieved chest pain after taking a nitroglycerin tablet could be indicative of a serious cardiac event. Instructing the client to call 911 is the most appropriate response because immediate medical attention is necessary for chest pain that is not relieved by nitroglycerin. Telling the client to take an aspirin (Choice A) may not address the urgency of the situation, and aspirin might not be appropriate depending on the client's medical history. Having the client take another nitroglycerin tablet (Choice C) without relief could lead to overdosage. Advising the client to come to the office (Choice D) is not the best course of action when dealing with a potential cardiac emergency that requires immediate intervention.

5. A client is telling the nurse in the clinic that he gets a headache after taking sublingual nitroglycerin (Nitrostat) for his angina pain. Which of the following should the nurse instruct the client to do?

• A. Reduce the nitroglycerin dose
• B. Ask the provider to prescribe a strong analgesic
• C. Lie down in a cool environment and rest
• D. Ask the provider to prescribe a different medication

Correct answer: C

Rationale: The correct answer is to instruct the client to lie down in a cool environment and rest after taking sublingual nitroglycerin for angina pain. Headaches are a common side effect of nitroglycerin due to its vasodilatory effects, and resting in a cool environment can help alleviate the headache. Reducing the nitroglycerin dose is not recommended without consulting the healthcare provider as it may compromise the effectiveness of the medication in managing angina. Asking for a strong analgesic is not appropriate since the headache is likely related to the nitroglycerin and not a separate issue requiring a pain reliever. Requesting a different medication should also involve consulting the healthcare provider to ensure an appropriate alternative is prescribed for angina management.

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