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 B

Explanation

Choice A reason: This is incorrect. Walking directly in front of the client may block their view and increase their risk of falling. The nurse should walk to the side and slightly behind the client to provide support and guidance³.

Choice B reason: This is correct. Walking along the affected left side allows the nurse to assist the client with balance, weight shifting, and foot clearance. The nurse should also encourage the client to use the handrail on their strong side³.

Choice C reason: This is incorrect. Walking directly behind the client may not allow the nurse to see the client's gait pattern or intervene quickly if the client loses balance. The nurse should walk to the side and slightly behind the client to monitor and assist them³.

Choice D reason: This is incorrect. Walking along the unaffected right side may not provide adequate support or protection for the client's affected side. The nurse should walk along the affected left side to help the client with their hemiplegic gait³.

A. Vitamin B12 contributes to the increased production of RBCs after significant blood loss. B. Vitamin B12 is needed to prevent excessive production of red blood cells. C. Vitamin B12 is needed to prevent RBCs from sticking together. D. Your stomach does not provide a substance necessary for the absorption of vitamin B12.

Correct Answer is D

Explanation

Choice A reason: Vitamin B12 does not contribute to the increased production of RBCs after significant blood loss. Vitamin B12 is a type of vitamin that is essential for the normal formation and maturation of red blood cells (RBCs), which carry oxygen throughout the body. ¹ However, vitamin B12 does not increase the production of RBCs in response to blood loss. That is the role of erythropoietin, a hormone that stimulates the bone marrow to produce more RBCs. ²

Choice B reason: Vitamin B12 is not needed to prevent excessive production of red blood cells. Vitamin B12 is needed for the normal production of red blood cells, not for the prevention of overproduction. Excessive production of red blood cells, also known as polycythemia, can cause the blood to become thick and viscous, increasing the risk of clotting and stroke. ³ Polycythemia can be caused by various factors, such as smoking, dehydration, or genetic mutations, but not by a lack of vitamin B12.

Choice C reason: Vitamin B12 is not needed to prevent RBCs from sticking together. Vitamin B12 is needed for the normal formation and maturation of RBCs, not for the prevention of aggregation. RBCs can stick together and form clumps, also known as rouleaux, which can impair blood flow and oxygen delivery. Rouleaux can be caused by various factors, such as inflammation, infection, or cancer, but not by a lack of vitamin B12.

Choice D reason: Vitamin B12 is needed for the normal formation and maturation of RBCs, but it cannot be absorbed by the body without a substance called intrinsic factor. Intrinsic factor is a protein that is produced by the stomach and binds to vitamin B12, allowing it to be absorbed by the small intestine. ¹ Pernicious anemia is a type of anemia that occurs when the stomach does not produce enough intrinsic factor, leading to vitamin B12 deficiency. The only way to treat pernicious anemia is by giving vitamin B12 injections, which bypass the need for intrinsic factor.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has little use of the left side due to a stroke. To assist with ambulation for the first time, the nurse should walk:

Correct Answer is B

Explanation

The client with pernicious anemia asks why vitamin B12 injections are necessary. What is the best response by the nurse?

Correct Answer is D

Explanation

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