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A nurse is caring for a newly-admitted client.

Exhibits
The nurse is developing a plan of care with a cardiac rehabilitation team. Which of the following topics should the nurse recommend the team plan to address with the client? Select all that apply.

Cardioversion therapy

Relaxation techniques

Potential pacemaker placement

Blood pressure management

Meal planning ideas

Nitroglycerin self-administration

Physical activity recommendations

Smoking cessation program

Answer and Explanation

Correct Answer : B,D,E,F,G,H

Rationale:

A. Cardioversion therapy: There is no evidence of arrhythmias requiring cardioversion, such as atrial fibrillation or ventricular tachycardia. The client’s rhythm disturbances are not documented, and this is not relevant to their current clinical condition.

B. Relaxation techniques: The client has a long-standing history of generalized anxiety disorder and is exhibiting current anxiety with fear of dying. Incorporating relaxation strategies can reduce cardiac workload, support mental health, and prevent future anxiety-related complications.

C. Potential pacemaker placement: There is no indication of conduction delays, bradyarrhythmias, or heart block that would warrant pacemaker therapy. The client's vital signs and cardiac history do not support this as a current or anticipated need.

D. Blood pressure management: Although BP is currently stable, the client is post-MI with a history of hyperlipidemia and smoking. Ongoing BP control reduces strain on the heart and is vital to secondary prevention of cardiac events and stroke recurrence.

E. Meal planning ideas: The client is dissatisfied with the hospital diet and has no structured dietary practices at home. Providing cardiac-healthy meal planning strategies can improve lipid profile, manage weight, and prevent diet-related risk factor escalation.

F. Nitroglycerin self-administration: The client recently used nitroglycerin effectively for chest pain relief. Education on proper use, frequency, and when to seek emergency care is essential to empower the client in self-management and prevent complications.

G. Physical activity recommendations: The client currently avoids exercise due to fatigue but requires guided activity to support cardiac recovery. Tailored recommendations from rehab experts can improve endurance, reduce fatigue, and promote cardiovascular fitness safely.

H. Smoking cessation program: Although smoking less frequently, the client is still actively smoking. Smoking is a significant modifiable risk factor for recurrent MI and COPD exacerbation. A structured cessation program supports long-term abstinence and respiratory health.

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Correct Answer is C

Explanation

Rationale:

A. "The client is a member of the board of directors.": Personal or non-clinical information such as the client’s status or occupation is irrelevant to care delivery and violates confidentiality principles unless directly related to medical decision-making or care needs.

B. "The client was intubated without complications.": While this may be a useful detail in some cases, it is not as clinically relevant as reporting measurable data like blood loss. Intubation is standard for many surgeries, and if no complications occurred, it may not impact ongoing care.

C. "The estimated blood loss was 250 milliliters.": Estimated blood loss is a critical piece of information that affects postoperative care decisions, such as fluid replacement, monitoring for hypovolemia, and vital sign trends. It is an essential component of the PACU-to-floor hand-off.

D. "There was a total of 10 sponges used during the procedure.": Sponge counts are important intraoperatively to ensure none are retained, but this detail is primarily documented in surgical records. It is not routinely included in hand-off reports unless a count discrepancy occurred.

A. Institutional policies and procedures B. written prescription from the provider C. State Nurse Practice Act D. verbal direction from the nurse manager

Correct Answer is C

Explanation

Rationale:

A. Institutional policies and procedures: While helpful in guiding facility-specific protocols, policies do not override state regulations. An institution may allow tasks that exceed or fall short of legal scope, so this should not be the primary reference.

B. Written prescription from the provider: A provider’s order does not define or expand a nurse’s legal scope of practice. Even with a valid order, the nurse must independently verify whether they are legally permitted to carry out the task.

C. State Nurse Practice Act: The Nurse Practice Act (NPA) is the legal authority that defines what licensed nurses are permitted to do in their state. It is the most authoritative resource to determine whether a task is within the nurse’s legal scope of practice.

D. Verbal direction from the nurse manager: Even when given by a superior, verbal instructions must still comply with state law. A nurse manager’s guidance cannot authorize a task that lies outside the nurse’s legal scope.

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A nurse is caring for a newly-admitted client. Exhibits The nurse is developing a plan of care with a cardiac rehabilitation team. Which of the following topics should the nurse recommend the team plan to address with the client? Select all that apply.

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A nurse is caring for a newly-admitted client.

Exhibits
The nurse is developing a plan of care with a cardiac rehabilitation team. Which of the following topics should the nurse recommend the team plan to address with the client? Select all that apply.