A nurse is caring for a client who has angina and reports a feeling of heaviness in the chest while ambulating in the hall. Which of the following actions should the nurse take first?

Obtain a 12-lead ECG for the client.

Have the client stop walking and sit down.

Administer sublingual nitroglycerin to the client.

Measure the client's vital signs.

Answer and Explanation

The Correct Answer is B

Rationale:

A. Obtain a 12-lead ECG for the client: An ECG is important for diagnosing myocardial ischemia or infarction, but it is not the immediate first step. The priority is to stop activity and reduce myocardial oxygen demand before further diagnostics.

B. Have the client stop walking and sit down: Angina is often triggered by physical exertion. Stopping activity and sitting down reduces oxygen demand on the heart, alleviates symptoms, and prevents further ischemia. This is the most immediate and essential first action.

C. Administer sublingual nitroglycerin to the client: Nitroglycerin helps relieve anginal pain by dilating coronary arteries, but it should be given after the client has stopped activity and rested. Administering it while the client is still active may not be effective or safe.

D. Measure the client's vital signs: While vital signs are important for assessing the client’s current status, the priority is to stop exertion, which is likely contributing to myocardial oxygen imbalance. Assessment follows immediate symptom relief measures.

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Correct Answer is C

Explanation

Rationale:

A. Providing the client with information about transportation services: This helps address access barriers but focuses on support services rather than directly organizing or integrating healthcare delivery, which is central to coordination of care.

B. Informing the client about providers who accept their health insurance: While helpful, this action centers on financial guidance. It supports access but does not actively bridge or organize care among multiple services or settings.

C. Arranging an appointment for the client with a mobile health clinic: Coordinating an appointment directly connects the client with needed services, especially in underserved rural areas. This reflects active care coordination by ensuring timely access to care and reducing system fragmentation.

D. Encouraging the client to become a self-advocate: Promoting self-advocacy empowers the client in their health journey but does not represent coordination of care. Coordination involves organizing and facilitating access across providers and settings.

A. Subdural hematoma B. Renal calculi C. Hyperthyroidism D. Diabetes mellitus

Correct Answer is A

Explanation

Rationale:

A. Subdural hematoma: This condition increases the risk of complications during electroconvulsive therapy (ECT) due to potential elevated intracranial pressure. The seizure activity induced by ECT can further increase pressure and pose a risk of brain herniation or worsening of the hematoma.

B. Renal calculi: Kidney stones may cause pain and hematuria, but they do not directly increase the risk of complications during ECT. Unless there is severe renal impairment or electrolyte imbalance, ECT is generally safe for these clients.

C. Hyperthyroidism: While hyperthyroidism may increase sensitivity to stress or elevate the risk of arrhythmias during procedures, it does not present the same level of direct neurological risk as intracranial pathology like a subdural hematoma.

D. Diabetes mellitus: Diabetes requires careful monitoring during ECT, especially regarding fasting, blood glucose levels, and anesthetic recovery. However, it is not a contraindication and does not present as high a procedural risk as a brain bleed would.

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A nurse is caring for a client who has angina and reports a feeling of heaviness in the chest while ambulating in the hall. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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