A nurse is reviewing the client's diagnostic results and vital signs.
Which of the following actions should the nurse take? Select all that apply.
Anticipate client to be prepped for cardiac catheterization.
Assist with a continuous heparin infusion.
Encourage the client to ambulate.
Anticipate an increased dosage of metoprolol.
Obtain a prescription for client to be NPO.
Request a prescription for an antibiotic.
Correct Answer : A,B,D,E
Chest pain radiating to the left arm is characteristic for angina in coronary artery disease. This is suggested more by the client’s medical history of hypertension, hyperlipidemia and type 2 diabetes mellitus.
Clients with angina are scheduled for diagnostic cardiac catheterization to assess the extent of coronary blockage
Heparin is used to prevent the propagation of a clot that is formed on an unstable atherosclerotic plaque. Beta blockers are prescribed to lower the heart rate. This reduces the myocardial demand for oxygen.
The firstline medication include antiplatelets unless there's concurrent venous thromboembolism.
Keeping the client NPO within 2 hours of the procedure is important to prevent aspiration whole under sedation.
Ambulation increases demand on the heart which may worsen the pain Antibiotics have no role in coronary artery disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bladder spasms are a common postoperative complication after TURP, and they are typically associated with the irritation of the bladder wall. Cold compresses may be helpful for reducing muscle spasms or swelling in other situations, but they are not typically effective for relieving bladder spasms specifically.
B. Securing the urinary catheter is important to prevent dislodgement and ensure proper drainage. However, securing it to the upper left quadrant of the abdomen is not a standard practice.
C. The appropriate response is often to irrigate the catheter to relieve the obstruction and restore normal flow. While 0.9% sodium chloride (normal saline) is typically used for irrigation, the term "intermittent" refers to manually irrigating the catheter at intervals to flush out any blockages, which is an appropriate approach when there is a concern about obstruction.
D. Encouraging the client to urinate every 2 hours is not feasible or necessary in this situation.
Correct Answer is B
Explanation
B. Urinary incontinence can increase fall risk due to the need for frequent trips to the bathroom, which may increase the chances of tripping or falling, especially if the client rushes to the bathroom.
A. This indicates that the client is aware of their limitations and is proactive in seeking assistance, which may actually decrease their fall risk. It demonstrates awareness and caution.
C. While having a caregiver present can provide support and assistance, it doesn't necessarily indicate an increased fall risk. In fact, having a caregiver present may decrease the risk of falls by providing supervision and assistance as needed.
D. Bronchitis itself does not directly contribute to an increased fall risk.
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