Which statement, made by the client with coronary artery disease, alerts the nurse that the client may be experiencing difficulty adapting to the illness?

"I feel a little anxious when I get chest discomfort."

"I know that I should carry my medication with me in case I develop chest pain."

"My wife and I will learn to cook using the 'good' cooking oils."

"I usually wait about two hours after I feel chest discomfort to seek medical attention."

Answer and Explanation

The Correct Answer is D

Choice A reason: This is not an alarming statement. Feeling a little anxious when experiencing chest discomfort is a normal and understandable reaction. Chest discomfort can be a sign of angina, which is a condition where the heart muscle does not get enough oxygen due to reduced blood flow. Angina can cause pain, pressure, or tightness in the chest, and can be triggered by physical or emotional stress. The client should try to relax and take their medication as prescribed to relieve the discomfort.

Choice B reason: This is not an alarming statement. Knowing that they should carry their medication with them in case they develop chest pain is a sign of good self-care and awareness. The client should have a quick-relief medication, such as nitroglycerin, that can dilate the coronary arteries and improve the blood flow to the heart. The client should take the medication as soon as they feel chest pain and follow the instructions on how to use it.

Choice C reason: This is not an alarming statement. Learning to cook using the "good" cooking oils is a sign of positive lifestyle change and adaptation. The client should avoid or limit the intake of saturated and trans fats, which can raise the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is also known as the "bad" cholesterol because it can deposit on the walls of the arteries and cause atherosclerosis, which is the narrowing and hardening of the arteries. The client should use unsaturated fats, such as olive oil, canola oil, or sunflower oil, which can lower the LDL cholesterol and increase the high-density lipoprotein (HDL) cholesterol. HDL cholesterol is also known as the "good" cholesterol because it can remove the excess cholesterol from the arteries and transport it to the liver.

Choice D reason: This is the alarming statement. Waiting about two hours after feeling chest discomfort to seek medical attention is a sign of denial and delay. Chest discomfort can be a symptom of a heart attack, which is a life-threatening emergency where the blood flow to the heart is blocked and the heart muscle begins to die. The client should seek immediate medical attention if they experience chest pain that lasts more than a few minutes, or if it is accompanied by other signs, such as shortness of breath, nausea, sweating, or arm or jaw pain. The sooner the client receives treatment, the better the chance of survival and recovery.

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Correct Answer is A

Explanation

Choice A reason: This is the correct answer. Tremors and twitching are signs of hypomagnesemia, which is a low level of magnesium in the blood. Magnesium is a mineral that is involved in many enzymatic reactions and neuromuscular functions. A low magnesium level can cause hyperexcitability of the nerves and muscles, leading to involuntary movements and spasms. Alcoholism can cause hypomagnesemia by reducing the absorption and increasing the excretion of magnesium.

Choice B reason: Positive Chvostek's sign is not a sign of hypomagnesemia, but of hypocalcemia, which is a low level of calcium in the blood. Calcium is another mineral that is important for the function of nerves and muscles. A low calcium level can cause tetany, which is a condition of sustained muscle contraction. Chvostek's sign is a test that involves tapping the facial nerve in front of the ear and observing for a twitching of the facial muscles. A positive Chvostek's sign indicates hypocalcemia, not hypomagnesemia.

Choice C reason: Decreased deep tendon reflexes are not a sign of hypomagnesemia, but of hypermagnesemia, which is a high level of magnesium in the blood. A high magnesium level can cause hyporeflexia, which is a reduced or absent response to stimuli. Magnesium has a sedative effect on the nerves and muscles, and can inhibit the transmission of impulses. Hypermagnesemia can be caused by excessive intake or impaired excretion of magnesium.

Choice D reason: Polyuria and flank pain are not signs of hypomagnesemia, but of kidney problems, such as infection, stones, or failure. Polyuria is the production of abnormally large amounts of urine, and flank pain is the pain in the side or back below the ribs. These symptoms can indicate damage or inflammation of the kidneys, which can affect the balance of fluids and electrolytes in the body. Hypomagnesemia does not directly cause polyuria or flank pain, but it can be a result of kidney dysfunction.

A. Take a baby aspirin with a full glass of cold water at bedtime. B. You can take 81 mg of enteric coated aspirin with orange juice at lunch time. C. It's ok to take the aspirin with some ginseng tea in the evening. D. Take the aspirin with a glass of milk or food in the morning.

Correct Answer is D

Explanation

Choice A reason: Taking a baby aspirin with a full glass of cold water at bedtime is not a good discharge instruction for this client. Aspirin can increase the risk of bleeding, especially in the stomach and intestines. ¹ Taking aspirin at bedtime may increase the exposure of the GI mucosa to the drug and worsen the bleeding. ² Cold water may also irritate the stomach lining and cause discomfort.

Choice B reason: Taking 81 mg of enteric coated aspirin with orange juice at lunch time is not a good discharge instruction for this client. Enteric coated aspirin is designed to dissolve in the small intestine, not the stomach, to reduce the risk of GI bleeding. ³ However, orange juice is acidic and may damage the coating and release the aspirin in the stomach. ⁴ This may increase the bleeding and cause pain or ulcers.

Choice C reason: Taking the aspirin with some ginseng tea in the evening is not a good discharge instruction for this client. Ginseng is an herbal supplement that may interact with aspirin and increase the risk of bleeding. ⁵ Taking the aspirin in the evening may also have the same drawbacks as taking it at bedtime, as explained in choice A.

Choice D reason: Taking the aspirin with a glass of milk or food in the morning is the best discharge instruction for this client. Milk and food can help protect the stomach lining from the irritating effects of aspirin and reduce the risk of bleeding. Taking the aspirin in the morning can also minimize the exposure of the GI mucosa to the drug during the night, when the stomach is empty and more vulnerable. ²

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Which statement, made by the client with coronary artery disease, alerts the nurse that the client may be experiencing difficulty adapting to the illness?

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Naxlex Comprehensive Predictor Exams

A client with alcoholism is admitted to a medical-surgical unit with a serum magnesium level of 0.9 mEq/L. Which clinical manifestations would the nurse expect to find in this client?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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