Try Naxlex NCLEX-RN (Free-Trial)

The nurse is planning care for the client. Which of the following provider prescriptions should the nurse anticipate? Select All That Apply

Exhibits

Administer morphine 4 mg IV bolus

Prepare client for an exercise tolerance test.

Administer an intermittent IV fluid bolus.

Administer nitroglycerin sublingual.

Place the client in the supine position.

Apply oxygen at 2 L/min via nasal cannula.

Prepare client for percutaneous coronary intervention.

Answer and Explanation

Correct Answer : A,D,F,G

Rationale:

A. Administer morphine 4 mg IV bolus: Morphine is appropriate for severe chest pain unrelieved by nitrates. It decreases preload, pain, and anxiety, reducing myocardial oxygen demand. This intervention helps improve comfort and may lower sympathetic nervous system activation during an acute MI.

B. Prepare client for an exercise tolerance test: This is contraindicated during active chest pain and elevated troponin levels. Stress testing would increase cardiac workload and worsen ischemia. It is only done when a patient is stable and MI has been ruled out.

C. Administer an intermittent IV fluid bolus: Fluid boluses are not indicated unless hypotension or hypovolemia is present. Extra fluid can increase cardiac workload and worsen outcomes in MI. In a normotensive patient with chest pain, it offers no benefit and may increase risk of pulmonary congestion.

D. Administer nitroglycerin sublingual: Nitroglycerin is a first-line medication for ischemic chest pain. It improves blood flow by dilating coronary arteries and reducing cardiac preload. It can rapidly relieve angina and should be administered as soon as possible in acute chest pain.

E. Place the client in the supine position: Supine positioning may worsen breathing difficulty and is not ideal during acute chest pain. A semi-Fowler's position is better to support oxygenation. Keeping the head elevated helps reduce venous return and cardiac workload.

F. Apply oxygen at 2 L/min via nasal cannula: Oxygen is appropriate with labored respirations and signs of hypoxia. It improves oxygen delivery to the myocardium during ischemic events. Supplemental oxygen can help stabilize oxygen saturation while definitive interventions are underway.

G. Prepare client for percutaneous coronary intervention: PCI is a key treatment for myocardial infarction and should be anticipated given the client’s chest pain, elevated troponin, and high risk profile. It restores perfusion to the affected coronary artery and reduces infarct size and mortality when performed promptly.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"B"},"D":{"answers":"A,B"},"E":{"answers":"B"}}

Explanation

Rationale:

Troponin I level: An elevated troponin I level indicates myocardial cell injury and is a key diagnostic marker for MI. Even a value at the upper limit of normal (0.03 ng/mL) warrants concern, especially with accompanying symptoms.
ECG result – sinus tachycardia: Sinus tachycardia is nonspecific but may occur in both MI and angina due to pain, anxiety, or sympathetic stimulation. However, more definitive MI-related changes like ST elevation or Q waves would provide clearer diagnostic value.
Heart rate: A heart rate of 116/min is elevated and may represent the body’s response to pain, hypoxia, or stress. This can be seen in both angina and MI, though persistent or worsening tachycardia in MI may indicate hemodynamic instability.
Heart palpitations: Palpitations are common during episodes of angina and are often due to increased sympathetic tone or transient arrhythmias. They are usually mild and resolve with rest or nitroglycerin in stable angina.
Blood pressure: A blood pressure of 158/92 mm Hg indicates hypertension, a known trigger and risk factor for angina. Elevated BP increases myocardial oxygen demand, potentially precipitating chest pain in those with coronary artery disease.

A. The nurse provides wound care to a client at the time promised to the client. B. The nurse refers a client who has chronic obstructive pulmonary disease for palliative care services. C. The nurse declines to inform a client's neighbor about the client's prognosis. D. The nurse files an incident report regarding a medication error.

Correct Answer is B

Explanation

Rationale:

A. The nurse provides wound care to a client at the time promised to the client: Providing care as scheduled reflects reliability and professionalism, but it does not involve speaking up for or securing specific services in the client's best interest, which defines advocacy.

B. The nurse refers a client who has chronic obstructive pulmonary disease for palliative care services: This demonstrates advocacy by ensuring the client has access to specialized care that supports comfort, dignity, and symptom management—especially important in progressive, life-limiting illness.

C. The nurse declines to inform a client's neighbor about the client's prognosis: This action protects client confidentiality and privacy, which is ethically correct, but it does not represent active support or promotion of the client's needs or preferences.

D. The nurse files an incident report regarding a medication error: Filing an incident report supports patient safety and institutional accountability. However, it does not reflect direct advocacy, as it does not involve pursuing specific care or services for the client.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is planning care for the client. Which of the following provider prescriptions should the nurse anticipate? Select All That Apply Exhibits

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client in the emergency department. Exhibits For each assessment finding, click to specify if the finding is consistent with myocardial infarction or angina. Each finding may support more than one disease process

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"B"},"D":{"answers":"A,B"},"E":{"answers":"B"}}

Explanation

A nurse is caring for a group of clients. In which of the following scenarios is the nurse acting as a client advocate?

Correct Answer is B

Explanation

A nurse is caring for a client who is intubated and receiving mechanical ventilation for heroin toxicity. Which of the following assessments is the nurse's priority?

A nurse is caring for a client who is hemorrhaging and hypotensive from esophageal variceal bleeding. Which of the following actions should the nurse take first?

A nurse is caring for a client who is hemorrhaging and hypotensive from esophageal variceal bleeding. Which of the following actions should the nurse take first?

An emergency room nurse is assessing a client who has asthma and difficulty breathing. Which of the following findings should indicate to the nurse that the client is experiencing status asthmaticus?

A nurse notes that a client's eyes are protruding slightly from their orbits. Which of the following laboratory findings should the nurse expect?

A nurse is caring for a client who is receiving a transfusion of packed RBCs. The nurse notes that the client's blood type is AB positive and the blood infusing is labeled type B negative. Which of the following actions should the nurse take?

A nurse is planning care for a client who is receiving intermittent IV fluids via a peripherally inserted central catheter (PICC). Which of the following information should the nurse include in the client's plan of care?

The nurse is planning care for the client. Which of the following provider prescriptions should the nurse anticipate? Select All That Apply

Exhibits