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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.

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Correct Answer is B

Explanation

Rationale:
A. "If I can keep my HbA1c less than 6.5% (less than 7%), I will be cured of diabetes.": Maintaining an HbA1c below 7% is important for managing type 1 diabetes and reducing complications, but it does not eliminate the disease. Type 1 diabetes is a lifelong condition due to permanent loss of insulin production.

B. "I will check my blood sugar level before exercising.": Blood glucose monitoring before physical activity is essential to prevent hypoglycemia. Exercise lowers blood sugar levels, and clients with type 1 diabetes must assess their levels beforehand to determine if carbohydrate intake or insulin adjustment is needed.

C. "I should have my eyes checked every 2 years.": Clients with type 1 diabetes should have a comprehensive dilated eye exam annually, not every two years, to monitor for diabetic retinopathy, a common microvascular complication.

D. "I should soak my feet daily in warm, soapy water.": Soaking the feet is not recommended because it can lead to skin maceration and increase the risk of infection. Gentle washing and thorough drying—especially between the toes—are safer practices for foot care.

A. Contact the provider who will be performing the procedure. B. Instruct the client's spouse to sign the consent form. C. Read the consent form to the client using words the client will understand. D. Provide teaching about the surgical procedure for the client.

Correct Answer is A

Explanation

Rationale:
A. Contact the provider who will be performing the procedure: It is the provider’s legal and ethical responsibility to explain the procedure, including its purpose, risks, benefits, and alternatives. If the client does not understand, the nurse must contact the provider to clarify and ensure informed consent is valid.

B. Instruct the client's spouse to sign the consent form: A spouse may only sign the form if the client is legally unable to do so. If the client is competent but lacks understanding, they should not sign until they receive adequate information from the provider.

C. Read the consent form to the client using words the client will understand: While the nurse can clarify terms, reading or paraphrasing the consent form does not replace the provider’s obligation to explain the procedure fully and answer questions.

D. Provide teaching about the surgical procedure for the client: Nurses may reinforce information, but only the provider can give the detailed explanation required for informed consent. Providing full procedural teaching falls outside the nurse’s scope for consent purposes.

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

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Exhibits