A male client who recently had a myocardial infarction tells the practical nurse (PN) that he refuses to give up his habit of smoking two packs of cigarettes daily. Which intervention(s) should the PN implement? Select all that apply.

Ask if he understands the consequences of continuing to smoke.

Encourage the client to substitute cigars for the cigarettes.

Recommend an acupuncturist to assist with smoking cessation efforts.

Reinforce information about consequences related to smoking and heart disease.

Record the client's exact words in the electronic medical record.

Answer and Explanation

Correct Answer : A,D,E

Choice A reason: Asking if the client understands the consequences of continuing to smoke is essential for assessing his level of awareness about the risks associated with smoking, especially after a myocardial infarction. This step helps gauge the client's knowledge and can serve as a starting point for providing further education. It opens up a dialogue where the nurse can discuss the detrimental effects of smoking on cardiovascular health and the increased risk of recurrent heart attacks. Understanding the client's perspective and providing education can foster a more informed decision-making process and may encourage the client to consider quitting smoking.
Choice B reason: Encouraging the client to substitute cigars for cigarettes is not a recommended intervention. Cigars, like cigarettes, contain nicotine and other harmful chemicals. Substituting one form of tobacco for another does not reduce the health risks associated with smoking. Cigars can also lead to nicotine addiction and contribute to heart disease and other health issues. The goal should be to support the client in achieving complete smoking cessation rather than replacing one harmful habit with another. This approach does not align with evidence-based practices for promoting health and reducing cardiovascular risks.
Choice C reason: Recommending an acupuncturist to assist with smoking cessation efforts is an alternative therapy that some individuals may find beneficial. However, it should not be the first-line recommendation. Evidence-based strategies such as nicotine replacement therapy, medications, and counseling should be prioritized. Acupuncture can be considered as a complementary therapy in conjunction with these proven methods. It is important to provide the client with a range of options and support them in choosing the most effective and suitable approach for smoking cessation. However, this option alone does not address the immediate need for education and support regarding the risks of continued smoking.
Choice D reason: Reinforcing information about the consequences related to smoking and heart disease is crucial. Education plays a significant role in helping the client understand the impact of smoking on cardiovascular health. Providing detailed information about how smoking contributes to heart disease, the benefits of quitting, and the potential for improved outcomes can motivate the client to consider cessation. Reinforcement of this information helps to ensure that the client is fully aware of the serious health risks and the importance of quitting smoking to prevent further cardiovascular events.
Choice E reason: Recording the client's exact words in the electronic medical record is important for accurate documentation and continuity of care. This documentation provides a clear record of the client's statements, attitudes, and intentions regarding smoking. It ensures that all members of the healthcare team are informed of the client's position and can tailor their interventions accordingly. Accurate documentation also helps in tracking the client's progress and responses to interventions over time, facilitating a coordinated and comprehensive approach to care.

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Correct Answer is A

Explanation

Choice A reason: Using a large cuff to obtain BP readings on either thigh is the appropriate action. With a history of a right radical mastectomy, blood pressure should not be taken on the right arm due to the risk of lymphedema. The left arm is also not suitable due to the recent surgery and cast. Therefore, the thigh is the best alternative site for accurate BP measurement.
Choice B reason: Measuring all vital signs every 2 hours except the BP is not appropriate because BP is a critical vital sign that needs to be monitored regularly, especially in postoperative clients. Omitting BP measurements could miss important changes in the client's condition.
Choice C reason: Obtaining manual BP readings with a cuff on the left arm is not recommended as the client has a recent surgical repair and cast on the left arm. This can cause discomfort and may not provide accurate readings.
Choice D reason: Quickly releasing air from the BP cuff on the right arm is not suitable due to the client's history of right radical mastectomy. This practice could exacerbate the risk of developing lymphedema in the affected arm.

A. Bathe the wound daily with soap and water. B. Record the color and temperature of the leg. C. Perform dorsiflexion and extension exercises. D. Check the client's dorsalis pedis and posterior tibialis pulse points.

Correct Answer is D

Explanation

Choice A reason: Bathing the wound daily with soap and water is a common practice to maintain cleanliness and prevent infection in a wound. However, this is not the immediate priority in this scenario. The presence of a dusky color on the left foot indicates potential vascular compromise, which needs to be assessed first to ensure adequate blood flow to the affected area. Cleaning the wound can be done subsequently, but checking circulation is critical to address any immediate risks.
Choice B reason: Recording the color and temperature of the leg is an important assessment step to monitor the client's condition. These observations can provide valuable information about the client's peripheral circulation and skin condition. However, while this should be done as part of the overall assessment, it is not the most immediate action. Checking the pulses will give more direct information about the blood supply to the affected area, which is crucial for identifying any urgent circulatory issues.
Choice C reason: Performing dorsiflexion and extension exercises can help maintain joint mobility and muscle strength in clients with diabetes. However, it is not the first intervention that should be implemented in this scenario. Before recommending exercises, it is essential to assess the vascular status of the client's foot. Exercises may not be appropriate if there is significant circulatory compromise, and could potentially cause further harm.
Choice D reason: Checking the client's dorsalis pedis and posterior tibialis pulse points is the most critical first intervention. The dusky color of the foot suggests a possible issue with blood flow. By assessing the pulses in the foot, the practical nurse can determine if there is adequate perfusion to the area. If the pulses are weak or absent, it may indicate peripheral artery disease or another vascular issue that requires immediate medical attention. Prompt identification and intervention are crucial to prevent further complications, such as tissue necrosis or limb-threatening ischemia.

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A male client who recently had a myocardial infarction tells the practical nurse (PN) that he refuses to give up his habit of smoking two packs of cigarettes daily. Which intervention(s) should the PN implement? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with a history of a right radical mastectomy arrives on the postoperative unit following surgical repair of a fractured left radius and application of a short arm cast. Which action should the practical nurse implement while obtaining the client's blood pressure (BP)?

Correct Answer is A

Explanation

A client with diabetes is admitted with a 1 cm size ulcer on the left great toe. The practical nurse (PN) observes that the left foot has a dusky color. While planning the client's care, which intervention should the PN implement first?

Correct Answer is D

Explanation

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