Nursing Elites

1. The nurse is caring for a client who has returned to the unit after undergoing a cardiac catheterization. The nurse should monitor for which common complication following this procedure?

• A. Hypertension
• B. Hypotension
• C. Hemorrhage
• D. Hyperglycemia

Correct answer: C

Rationale: Following a cardiac catheterization, a common complication to monitor for is bleeding or hemorrhage at the catheter insertion site. Hemorrhage is a significant concern due to the potential for rapid blood loss, leading to hypovolemic shock and other serious complications. Monitoring for signs of bleeding, such as swelling, hematoma, or drop in hemoglobin levels, is crucial for timely intervention. Hypertension is not a common complication post-cardiac catheterization; instead, hypotension may occur due to vasovagal response or bleeding. Hyperglycemia is not typically associated with cardiac catheterization unless the client has pre-existing diabetes or stress-induced hyperglycemia.

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. The healthcare professional is collecting data on a client who was just admitted to the hospital with a diagnosis of coronary artery disease (CAD). The client reveals having been under a great deal of stress recently. What should the healthcare professional do next?

• A. Ask whether the client wants to seek counseling or therapy.
• B. Explore with the client the sources of stress in their life.
• C. Reassure the client that stress is common in today's world.
• D. Ask the client to make a list of stressors for later evaluation.

Correct answer: B

Rationale: It is important for the healthcare professional to explore the sources of stress with the client to develop an effective stress management plan tailored to the individual's specific stressors. By understanding the sources of stress, healthcare professionals can identify triggers, implement appropriate interventions, and support the client's overall well-being. Option A is not the immediate next step as exploring the sources of stress should come before suggesting counseling or therapy. Option C is dismissive of the client's feelings and does not address the need for personalized stress management. Option D delays the process by asking the client to make a list without actively engaging in a discussion to identify stressors.

4. A client with peripheral artery disease (PAD) complains of pain in the legs while walking. Which instruction should the LPN/LVN reinforce to help alleviate the client's symptoms?

• A. Walk until the pain becomes severe, then rest.
• B. Perform leg exercises while sitting.
• C. Elevate the legs on pillows while resting.
• D. Take frequent breaks and walk shorter distances.

Correct answer: D

Rationale: The correct answer is to take frequent breaks and walk shorter distances. This instruction helps alleviate symptoms in clients with peripheral artery disease (PAD) by allowing them to manage pain and discomfort more effectively. Option A is incorrect as waiting for the pain to become severe before resting can exacerbate symptoms. Option B, performing leg exercises while sitting, may not directly address the issue of pain during walking. Option C, elevating the legs on pillows while resting, is beneficial for other conditions like edema but may not specifically help alleviate pain while walking in PAD clients.

5. A client has a new prescription for isoniazid. Which of the following instructions should the nurse include?

• A. Take the medication on an empty stomach.
• B. Avoid drinking alcohol.
• C. Take the medication with an antacid.
• D. Increase your intake of leafy green vegetables.

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid drinking alcohol. Isoniazid can cause liver damage, and alcohol consumption can increase this risk. Therefore, it is crucial to avoid alcohol while taking isoniazid to prevent potential liver complications. Choice A is incorrect because isoniazid is typically taken with food to reduce gastrointestinal upset. Choice C is incorrect because antacids can decrease the absorption of isoniazid. Choice D is incorrect as there is no specific recommendation to increase leafy green vegetable intake when taking isoniazid.

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