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: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.

A. glucose of 110 mg/dL. B. potassium of 3.0 mEq/L. C. calcium of 9.0 mg/dL. D. sodium of 133 mEq/L.

Correct Answer is B

Explanation

Choice A reason: Glucose of 110 mg/dL is not a finding that indicates digoxin toxicity. It is a normal blood glucose level for a fasting or non-fasting client.

Choice B reason: Potassium of 3.0 mEq/L is a finding that indicates digoxin toxicity. It is a low serum potassium level, which increases the risk of digoxin toxicity by enhancing the binding of digoxin to cardiac cells. The nurse should monitor the client for signs and symptoms of digoxin toxicity, such as nausea, vomiting, anorexia, fatigue, confusion, visual disturbances, and cardiac arrhythmias.

Choice C reason: Calcium of 9.0 mg/dL is not a finding that indicates digoxin toxicity. It is a normal serum calcium level for an adult client.

Choice D reason: Sodium of 133 mEq/L is not a finding that indicates digoxin toxicity. It is a slightly low serum sodium level, which may indicate hyponatremia, but not digoxin toxicity.

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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

Correct Answer is A

Explanation

The nurse should monitor the client for clinical manifestations of digoxin toxicity if the laboratory report reflects a serum:

Correct Answer is B

Explanation

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