The practical nurse (PN) is caring for a client with coronary artery disease who is admitted with intermittent chest pain. The admission laboratory results indicate elevations in troponin I and creatine phosphokinase myoglobin isoenzyme (CK-MB) levels. What should the PN consider the most significant risk for this client on the second day of admission?

The correct answer is choice C. Coffee-ground secretions draining via nasogastric tube suction.

Choice A rationale:

Oral ice chips eaten 30 minutes after vomiting postoperatively could be considered normal in some cases. However, this finding may not require immediate reporting to the RN unless

other concerning symptoms are present. Choice B rationale:

The inability to void 4 hours after discontinuing an indwelling catheter is not an immediate concern. It's not uncommon for some clients to experience difficulty urinating initially after catheter removal. The client should be closely monitored, and the RN should be informed if the situation persists or worsens.

Choice C rationale:

This is the correct answer because coffee-ground secretions draining via nasogastric tube suction can indicate bleeding in the gastrointestinal tract, potentially from the stomach or esophagus. This finding requires immediate attention as it could be a sign of a serious condition and may require urgent intervention.

Choice D rationale:

Ineffective pain management reported while using morphine PCA is a concern but may not be as critical as the coffee-ground secretions. The PN should still report this finding to the RN for appropriate assessment and possible adjustment of pain management, but it may not warrant immediate reporting.

The correct answers are:

A. Oatmeal is a good choice for breakfast.

C. Add lentils and black beans to soups.

D. Increase green leafy vegetables in the diet. Choice A rationale:

Oatmeal is a good choice for breakfast because it is a vegetarian option that is rich in iron. It contains non-heme iron, which is the type of iron found in plant-based foods. Non-heme iron may not be as easily absorbed as heme iron (found in animal products), but it can still contribute to increasing iron levels in the body, especially when combined with other sources of iron.

Choice B rationale:

Eat red meat just until the anemia is resolved is not a suitable instruction for a vegetarian client. Red meat is a source of heme iron, which is not part of a vegetarian diet. While heme iron is more easily absorbed by the body, there are other plant-based sources of iron that can be recommended to the client without compromising their dietary preferences.

Choice C rationale:

Lentils and black beans are excellent choices for a vegetarian client to increase iron intake. Both foods are rich in iron, and they also contain other nutrients that aid in iron absorption, such as vitamin C. Including lentils and black beans in soups can be a tasty and nutritious way to enhance iron intake.

Choice D rationale:

Increasing green leafy vegetables in the diet is another appropriate recommendation for a vegetarian client. Green leafy vegetables, such as spinach and kale, contain non-heme iron, as well as other essential vitamins and minerals that contribute to overall health. Combining them with vitamin C-rich foods can enhance iron absorption.

Choice E rationale:

Take two prenatal vitamins with iron daily is not necessary since the healthcare provider already prescribed one prenatal vitamin with iron daily. Taking additional supplements without medical advice can lead to an excessive intake of certain nutrients, which may have adverse effects on health.