A nurse is admitting a client who reports chest pain.

Exhibits

The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)

Obtain the client's vital signs.

Witness the client's signature on the Informed consent form.

Confirm the client's allergies.

inform the client of the risks of the procedure.

Mark the surgical site.

Answer and Explanation

Correct Answer : A,B,C

A. Obtain the client's vital signs: This is correct. Vital signs should be assessed to monitor the client's cardiovascular status before any invasive procedure, especially in the context of a myocardial infarction.
B. Witness the client's signature on the informed consent form: This is correct. The nurse should witness the client's signature on the informed consent form, ensuring that the client understands the procedure and consents to it.
C. Confirm the client's allergies: This is correct. Confirming allergies is crucial before any procedure to prevent allergic reactions to medications, contrast dye, or other substances used during the procedure.
D. Inform the client of the risks of the procedure: This is incorrect. It is the responsibility of the provider to explain the risks of the procedure in detail to the client. The nurse ensures that the client understands and that consent is given, but the nurse does not provide the detailed explanation of risks.
E. Mark the surgical site: This is incorrect. Marking the surgical site is typically done by the provider, not the nurse, and is required only if a surgical procedure is being performed, which is not the case for a cardiac catheterization.

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Correct Answer is C

Explanation

A. Dyspnea (difficulty breathing) may occur as the cancer progresses and affects the airway, but it is not typically the earliest manifestation of laryngeal cancer.
B. Weight loss can be a late manifestation of cancer, often associated with systemic effects, but it is not the first sign of laryngeal cancer.
C. Hoarseness is the earliest and most common symptom of laryngeal cancer. It occurs because the tumor affects the vocal cords, causing changes in the voice. This symptom often appears early in the disease process, especially in individuals with a history of smoking.
D. Dysphagia (difficulty swallowing) can occur as the tumor progresses and obstructs the throat, but it is usually a later symptom and not the first sign of laryngeal cancer.

A. “I will call the provider to get a prescription for discontinuing the IV heparin today.” B. “Warfarin takes several days to work so the heparin will be used until the warfarin reaches a therapeutic level.” C. “The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay.” D. “Both heparin and warfarin work together to dissolve the clots.”

Correct Answer is B

Explanation

A. Heparin should not be discontinued immediately after starting warfarin, as warfarin takes several days to reach therapeutic levels. Discontinuing heparin too early could put the client at risk for clotting.
B. Warfarin takes several days to reach a therapeutic effect, so heparin is continued initially to provide immediate anticoagulation until the warfarin becomes effective.
C. Heparin does not increase the effects of warfarin, but both medications are used together temporarily to ensure adequate anticoagulation until warfarin reaches therapeutic levels.
D. Neither heparin nor warfarin dissolves clots. They are anticoagulants that prevent further clot formation, not thrombolytics that break down existing clots.

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A nurse is admitting a client who reports chest pain. Exhibits The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)

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A nurse is admitting a client who reports chest pain.

Exhibits

The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)