Nursing Elites

1. The patient with a history of myocardial infarction (MI) is prescribed aspirin. What instruction should the nurse include in the discharge teaching?

• A. Take the aspirin with food to prevent gastrointestinal upset
• B. Discontinue the aspirin if experiencing ringing in the ears
• C. Take the aspirin at bedtime to minimize side effects
• D. Avoid taking aspirin if also taking other NSAIDs

Correct answer: A

Rationale: Taking aspirin with food is recommended to prevent gastrointestinal irritation and upset, which are common side effects of aspirin. It helps protect the stomach lining and reduce the risk of developing ulcers. This instruction is crucial in promoting medication adherence and minimizing discomfort for the patient. Choices B, C, and D are incorrect because discontinuing aspirin without consulting a healthcare provider, taking it at bedtime, or avoiding it if taking other NSAIDs can have negative consequences on the patient's health and treatment plan.

2. The LPN/LVN is assisting in caring for a client in the telemetry unit and is monitoring the client for cardiac changes indicative of hypokalemia. Which occurrence noted on the cardiac monitor indicates the presence of hypokalemia?

• A. Tall, peaked T waves
• B. ST-segment depression
• C. Prolonged P-R interval
• D. Widening of the QRS complex

Correct answer: B

Rationale: ST-segment depression can indicate hypokalemia, affecting the heart's electrical conduction. Hypokalemia leads to alterations in the repolarization phase of the cardiac action potential, resulting in ST-segment depression on the ECG. Tall, peaked T waves are indicative of hyperkalemia, not hypokalemia. A prolonged P-R interval is more commonly associated with first-degree heart block. Widening of the QRS complex is typically seen in conditions like bundle branch blocks or ventricular tachycardia, not specifically in hypokalemia.

3. A client with a diagnosis of myocardial infarction has a new activity prescription allowing the client to have bathroom privileges. As the client stands and begins to walk, the client begins to complain of chest pain. The nurse should take which action?

• A. Assist the client to get back into bed.
• B. Report the chest pain episode to the healthcare provider.
• C. Tell the client to stand still and take the client's blood pressure.
• D. Give a nitroglycerin (Nitrostat) tablet and assist the client to the bathroom.

Correct answer: A

Rationale: In a client with myocardial infarction experiencing chest pain during activity, the priority action is to stop the activity immediately to reduce the heart's workload and oxygen demand. Assisting the client back to bed helps in reducing stress on the heart and can prevent worsening of the condition. Reporting the chest pain episode to the healthcare provider is important but should not delay taking immediate action to alleviate symptoms. Taking the client's blood pressure and administering nitroglycerin are secondary actions after ensuring the client's safety and comfort. Therefore, the correct action is to assist the client back into bed.

4. The client has angina pectoris and is prescribed nitroglycerin patches. What instruction should the nurse provide to the client?

• A. Apply the patch to the chest and leave it in place for 24 hours
• B. Apply the patch to a different site each time to prevent skin irritation
• C. Remove the patch before going to bed to prevent tolerance
• D. Cut the patch in half if experiencing headaches

Correct answer: B

Rationale: The correct instruction for the nurse to provide to the client is to apply the nitroglycerin patch to a different site each time to prevent skin irritation. Rotating the application site is crucial to prevent skin irritation and ensure consistent absorption of the medication. Applying the patch to the same site can lead to skin irritation and decreased effectiveness. Removing the patch before going to bed is not necessary, as the patch can typically be worn for a specific duration. Cutting the patch in half if experiencing headaches is not recommended and can alter the dose of the medication.

5. A client with a history of coronary artery disease (CAD) is being discharged after angioplasty. Which instruction should the LPN/LVN reinforce to the client?

• A. You should report any chest pain or discomfort to your health care provider.
• B. Avoid all physical activity for the next 2 weeks.
• C. Return to work immediately after discharge.
• D. Take aspirin only if you experience chest pain.

Correct answer: A

Rationale: The correct instruction to reinforce is to 'Report any chest pain or discomfort to your health care provider.' This is crucial because chest pain post-angioplasty can indicate complications that need immediate attention. Choice A is incorrect because returning to work immediately may not be advisable after angioplasty, as the client needs time to recover. Choice B is incorrect because avoiding all physical activity for 2 weeks may not be necessary; instead, gradual resumption of activities is usually recommended. Choice D is incorrect because aspirin should be taken as prescribed by the healthcare provider, not just when chest pain occurs.

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