Nursing Elites

1. The healthcare provider is reinforcing instructions to a client with heart failure who is prescribed a low-sodium diet. The provider should advise the client to choose which food item?

• A. Canned soup
• B. Fresh vegetables
• C. Processed cheese
• D. Pickled vegetables

Correct answer: B

Rationale: Fresh vegetables are a suitable choice for clients on a low-sodium diet as they are naturally low in sodium and provide essential nutrients. In contrast, canned soup, processed cheese, and pickled vegetables tend to be high in sodium, which is not recommended for individuals with heart failure and on a low-sodium diet. Fresh vegetables are also rich in fiber, vitamins, and minerals, making them a healthier option compared to the other choices provided.

2. An ambulatory clinic nurse is interviewing a client who is complaining of flu-like symptoms. The client suddenly develops chest pain. Which question best assists the nurse in discriminating pain caused by a non-cardiac problem?

• A. Can you describe the pain to me?
• B. Have you ever experienced this pain before?
• C. Does the pain get worse when you breathe in?
• D. Can you rate the pain on a scale of 1 to 10, with 10 being the worst?

Correct answer: C

Rationale: The correct answer is C. Pain that worsens with breathing in can indicate pleuritic chest pain, which is non-cardiac in nature. This specific question helps in differentiating non-cardiac causes from cardiac causes of chest pain, as cardiac pain typically does not worsen with breathing. Choices A, B, and D are less specific in discriminating between cardiac and non-cardiac chest pain.

3. 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.

4. A client is admitted to the emergency department with a suspected myocardial infarction (MI). The nurse should prepare the client for which immediate diagnostic test?

• A. Chest x-ray
• B. Electrocardiogram (ECG)
• C. Echocardiogram
• D. Coronary angiography

Correct answer: B

Rationale: An Electrocardiogram (ECG) is the most immediate and essential test to diagnose a myocardial infarction (MI) and assess the extent of heart damage. An ECG can quickly identify changes in the heart's electrical activity, allowing prompt initiation of appropriate interventions. A chest x-ray (Choice A) may show other conditions affecting the heart, but it is not the immediate test of choice for diagnosing an MI. An echocardiogram (Choice C) and coronary angiography (Choice D) are valuable in further assessing cardiac function and anatomy post-MI but are not the first-line diagnostic tests due to their time-consuming nature compared to an ECG.

5. 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.

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